If you are interested in being placed on our waiting list to adopt a Brussels Griffon, please fill out this form and hit the 'submit' button at the bottom of this page. Please fill out all information as it will help us in deciding the best placement for you.

If you are a senior citizen we suggest that you consider adopting an older Brussels Griffon. A healthy Griffon can live 12 to 15 years and they really don't begin to show their age until about 13 years. Please think about how YOUR age and state of health will affect your new dogs' future. Many pets are abandoned because their caregiver has to leave them to enter a nursing home and their family members do not always have space, desire or the ability to care for a pet left displaced by such an event.

After you complete your application you will get a message saying "your application has been sent". You will receive a form letter acknowledgement confirming receipt of your application from a member of our staff in a week or two.

If you have a question about whether your application has been received, please contact Vicki O'Neill.

If you have a question about the dog you are interested in adopting, please contact the person listed on that dog's webpage to find out the status of that dog.

Thank you very much.

If there is a particular dog you are interested in, what is his/her name?

Your Name		Home Phone (example: 555-123-1234)
Address		Work Phone (example: 555-123-1234)
City, State and Zip Code		Occupation
Do you have an email address? Yes No		If yes, please enter it here:

If you do not have an email address, may we call you collect if we need to contact you?

Yes No

What type of Griffon are you most interested in adopting?

Would you be willing to adopt a Brussels Griffon mix? Yes No

Would you be willing to travel by car or airplane to pick up a rescue? Yes No

What situations would cause you to not be able to keep this dog?

Do you understand that in the event you are no longer able to keep this dog, you are required to return it to National Brussels Griffon Rescue, Inc.? Yes No

As with any rescue dog, Brussels Griffon are often not housebroken, have been abused in the past, or may have treatable medical problems and in some cases, these types of problems may not be realized until after the dog has been placed in its new home. If you are approved for adoption, are you willing to work with your new pet to give it the new life it deserves? Yes No

Please provide a brief paragraph describing yourself and how you would like to be contacted.

Which of the following bests describes your current residence?

Own Home Rent Apartment Rent Condo Rent House

If you rent or lease, the following information is required:

Name of Landlord		Home Phone (example: 555-123-1234)
Address		Work Phone (example: 555-123-1234)

Do you have a fenced yard on your property? Yes No

If Yes, what type of fence?

Wood Chain Link Other

How high is the fence?

How do you plan to allow your pet to relieve itself and/or exercise?

Do all adults in the household work full time? Yes No

Approximately how many hours each day will your dog be left alone?

Where will the dog be kept when left alone?

Do you have children living with you? Yes No

If yes, what are their ages?

What other animals do you have? List each: (include Breed, Age, Sex, Altered Status, Length of time with you)

If you have had pets in the past, what happened to them?

Under what circumstances do you believe a pet should not be spayed or neutered?

Are there any restrictions on the number of dogs you may own where you live? Yes No

If yes, how many are you allowed to have?

Does anyone in your home have allergies to animals? Yes No

Vet Reference

Do you have a veterinarian now, or one that you have used in the past? Yes No

Vet's Name:

Address:

Phone: (example: 555-123-1234)

Personal References

(1) Name:

Address:

Phone: (example: 555-123-1234)

Relationship to you:

(2) Name:

Address:

Phone: (example: 555-123-1234)

Relationship to you:

How did you hear about Brussels Griffon Rescue?

NBGR Rescue Disclaimer There is absolutely no guarantee made or implied that any person requesting to adopt a dog being fostered through NBGR, or posted on the NBGR website, will be allowed to adopt a dog. Rather, all adoption applications are subject to acceptance based on a review process that may require collecting information from references and visiting the applicant's home. All decisions on placing dogs in adoptive and foster homes are based solely on the judgment of the volunteers and coordinators of National Brussels Griffon Rescue, Inc. Adoption applications submitted through this form may be denied for various reasons. NBGR reserves the right to make all decisions regarding placement or final disposition of any rescued dog in its care whether in, or being placed in, a foster or adoptive home or other facility. By pressing the "Send Application" button you attest that you have read the above disclaimer and agree to the terms therein. Furthermore you represent that the information you have provided on this form is the truth to the best of your knowledge and belief.

Thank you for considering a rescue! I hereby forever release, discharge, and agree to hold harmless and indemnify Brussels Griffon Rescue, Inc.; its board of directors; and its members, Officers, and agents from all claims, demands, actions, causes of action, or liability of any kind whatsoever arising as a result of or in connection with the fostering or adoption of a dog sponsored by this organization.

NOTE: Please wait until you see the confirmation page that you're application has been sent before continuing. This could take a few seconds.