Name: *


Address: *


Home Phone: *


Work Phone:


Cell Phone: *


Other Phone:


E-Mail Address:


Total number of people living in home: *


Number of male adults living in home:


Number of female adults living in home:


Number of male children living in home:


Number of female children living in home:


Do you own or rent your home? *
Select one: Own Rent

What type of residence?
Select one: House Condo Apartment Town Home

If you rent, what is the name and phone number of your landlord?


How big is your yard (i.e., size of the area)?


Is your yard fenced?
Select one:
Yes
No

If your yard is fenced, describe the fence. What is the height? Material? Age? Other?


Where do your current pets stay when your not home (be specific)?


Where do your current pets sleep at night (be specific)?


Are you ready for a foster dog/puppy? *
Select one:
Yes
No

How many dogs/puppies can you comfortably foster?


Can you help provide transportation to pick up your foster dog?
Select one:
Yes
No

How many miles are you willing to transport?


What other restrictions do you have regarding transport?


Make and model and color of your vehicle:


Do you currently have auto insurance for this vehicle?
Select one:
Yes
No

Have you ever fostered for us or another organizations?
Select one:
Yes
No

If you have fostered with another organization, what is the name and location of the other organization?


What is the name and number of your contact person for the other organization?


How long were you actively involved with the other organization?


If you are fostering for another organization, describe current foster(s).


Do you work full-time? Part-time?
Select one:
Part-time
Full-time
I do not work

If you work, do you have the opportunity to come home during lunch?
Select one:
Yes
No
Some days

How many hours a day will your foster dog be alone?


How much time do you have to devote to socializing a foster?


How would you describe your home. (Select all that apply.)
Select one:
Lots of activity; always loud and boisterous
Not a lot of activity; quiet; mostly laid-back

Where will you keep the fosters during the day (be specific)?


Where do the fosters stay if you leave home for errands etc (be specific)?


Where will your foster dog/puppy sleep at night (be specific)?


What special talents or experience do you have for helping training and socialize these dogs?


What socialization problems would make you feel uncomfortable about a dog that was coming into your home?


Tell us anything that would help us to match a foster dog to you and your lifestyle.


Have you ever had to give up a dog/puppy? If so, why and where did the dog/puppy go?


Describe the type/types of dogs/puppies you prefer to foster (e.g., male or female, small, medium, or large, specific breed, temperament, etc).


Current number of family pets in home: *


Pet #1:
Select one:
Dog
Cat
Bird
Other (please specify under "Breed" below"

Name of Pet #1:


Sex of Pet #1:
Select one:
Male
Female

Age of Pet #1:


Weight of Pet #1:


Breed of Pet #1:


Temperment of Pet #1:


How long have you had Pet #1?


Is Pet #1 spayed or neutered?
Select one:
Yes
No

Date of last vet visit for Pet #1:


Is Pet #1 current on all vaccines?
Select one:
Yes
No

Name and phone number of vet clinic that administered vaccines for Pet #1?


First and last name Pet #1's vet record is under?


Pet #2:
Select one:
Dog
Cat
Bird
Other (please specify under "Breed" below"

Name of Pet #2:


Sex of Pet #2:
Select one:
Male
Female

Age of Pet #2:


Weight of Pet #2:


Breed of Pet #2:


Temperment of Pet #2:


How long have you had Pet #2?


Is Pet #2 spayed or neutered?
Select one:
Yes
No

Date of last vet visit for Pet #2:


Is Pet #2 current on all vaccines?
Select one:
Yes
No

Name and phone number of vet clinic that administered vaccines for Pet #2?


First and last name Pet #2's vet record is under?


Pet #3:
Select one:
Dog
Cat
Bird
Other (please specify under "Breed" below"

Name of Pet #3:


Sex of Pet #3:
Select one:
Male
Female

Age of Pet #3:


Weight of Pet #3:


Breed of Pet #3:


Temperment of Pet #3:


How long have you had Pet #3?


Is Pet #3 spayed or neutered?
Select one:
Yes
No

Date of last vet visit for Pet #3:


Is Pet #3 current on all vaccines?
Select one:
Yes
No

Name and phone number of vet clinic that administered vaccines for Pet #3?


First and last name Pet #3's vet record is under:


If you have more than three pets, please attach a separate text file (Micorsoft Word, .html or .rtf) with the following information for each pet: Name, type, sex, age, weight, breed, temperament, how long you have had the pet, if the pet is spayed or neutered, last vet visit, if the pet is current on vaccines, the name and number of the vet clinic that administered the vaccines, and the first and last name the pet's vet record is under.