ࡱ> { 2bjbjzz 8pJ*Bff8 DPvNf(,,,MMMMMMM$ORNN,,0Np,,MMN?GL,lT2wH0MFN0vNI"SY"S`LL&"S=LNNvN"Sf :  FOSTER APPLICATION We would like to thank you for your interest in helping to foster our dogs. Please answer the following questions honestly. All information will be treated as confidential. Submission of this application does not guarantee that you will be accepted as a foster home. Incomplete or misrepresentation of any facts on this application is reason for refusal. Applicants Full Name: ______________________________________________ Age: ____________ Spouse/Partners Full Name: _________________________________________ Age: ____________ Address ____________________________________________________________________________ City/State/Zip _______________________________________________________________________ Phone: (H) [____]____________ Phone: (C) [_____]__________ Phone: (W) [____]__________, if you can be called at work. Email Address _______________________________________________________________________ Do you check your email [ ] Daily [ ] Weekly [ ] Monthly [ ] Other Do you ? Rent _____ Own your home _____ How long at this address ____________________ If you rent does your rental agreement permit pets? [ ] Yes [ ] No Landlords name, address and phone number (required)_______________________________________ ____________________________________________________________________________________ If less than 2 yrs at this address, list previous address _________________________________________ Employer ________________________________ Employers phone number _____________________ List all others living in your home:Name _______________________________________Age _______ _____________________________________________ Age _______ _____________________________________________ Age _______ _____________________________________________ Age _______ _____________________________________________ Age _______ Pets primary caretaker _____________________________________________________ Will this be your childrens first experience with a dog as part of the family? Yes _____ No _____ If necessary, are you willing to take the pet to Obedience Classes? Yes _____ No _____ Have you ever taken a dog through an Obedience Class? Yes _____ No _____ When and what type of class was this: ____________________________________________________ Home Environment Which best describes your living situation: Home _____ Apartment _____ Mobile Home ______ Other:________________________________________________________ What type of area do you live in: City _____ Subdivision _____ Country_____ Town _____ What type of yard: No Yard _____ Small _____ Large _____ Acreage _______ Approximate size of yard: ___________________________________________ Fenced Yes _____ No _____ Type/height of fence? ______________________________ Is your fence secure and are the gates at ground level? [ ] Yes [ ] No Will the pet have to use steps to go potty? Yes _____ No _____ Which best describes potty accommodations? Run _____ Fenced yard _____ Kennel _____ Tie Out _____ Other: ________________________________________________________________ How many hours will the pet be left alone daily? Less than 1 _____ 2-4 _____ 6-8 _____ 8+ _____ Will you be able to let the dog out during the daytime? [ ] Yes [ ] No Where will the pet be kept while home alone? Loose in House _____ Confined in a room _____ Crate _____ Garage _____ Basement _____ Outdoors _____ Other: ______________________ Where will the pet be kept while you are home? Loose in House _____ Confined in a room _____ Crate _____ Garage _____ Basement _____ Outdoors _____ Other: ______________________ Training of Your Foster Dog Would your foster dog be living with or exposed to any of the following on a regular basis? Check all that apply. [ ] Other Dogs [ ] Cats [ ] Heavy Traffic [ ] Bicycles [ ] Horses [ ] Children under 10 [ ] Squirrels, Rabbits, Birds We strongly recommend that ALL foster dogs be crate trained, will you be able to adhere to this policy: [ ] Yes [ ] No When you go on vacation, where will your foster dog go? Do you have someone reliable who will care for it? Who? __________________________________________________________________________________. We can provide vacation care if advance notice of need is given, no less than one month prior to your departure date. What Behaviors/Conditions Would You Have a Hard Time Dealing With in a Foster Dog? Check all that apply: [ ] Stubbornness [ ] Fear of Humans [ ] Dominance [ ] Aggression/Biting [ ] Not Housebroken [ ] Excessive Shedding [ ] Destructive Chewing [ ] Overly Protective [ ] Escaping Behavior [ ] Digging Problems [ ] Submissive Traits [ ] Playing too Rough [ ] Submissive Peeing [ ] Jumping on People [ ] Separation Anxiety [ ] Overly Energetic [ ] Excessive Barking [ ] Excessively Needy [ ] Not Good with Other Pets [ ] Herding other Dogs, Cats, Children [ ] Nervous or Shy Behavior Your Other Pets/Animals Please list all other animals that you have owned in the last five years (living or deceased). NameType of AnimalSpayed or Neutered?AgeOwned how long?on Heartworm PreventiveUp to date on vaccinations or when due If any of the above animals you no longer have, why, what reason and how long ago? _________________ ______________________________________________________________________________________ ______________________________________________________________________________________. Do any of your current pets have a medical condition? If yes, please explain: ________________________ _______________________________________________________________________________________ How do you exercise your current dog(s)? ____________________________________________________ Please Answer the Following Questions: Are you willing to allow a home visit by appointment? _______________________________________ Have you ever been bitten/attacked by a dog? If yes, please explain: _____________________________ ________________________________________________________________________________________ Do you have experience with newborn/nursing moms and young animals? _____ Yes ____ No If yes, please describe: __________________________________________________________________ Are you comfortable and/or knowledgeable in basic medical dog care (deworming, ear infection, administering medications, etc.) ______ Yes ____ No __________________________________ Are you willing to foster a special needs dog? _____ Yes ____ No Do you have the means to isolate your foster from your own dogs? ____ Yes ____ No Have you ever fostered with another group? ___ Yes ___ No If yes, when ____________________, Name of organization/group? ____________________________________________________________ What do you hope to gain from your fostering experience with Second Chance Small Dog Rescue? _____________________________________________________________________________________ _____________________________________________________________________________________ Are you willing and able to transport your foster dog to the vet for medical care? ____ Yes ____ No Please list (3) people who have known you for at least 2 years. Please list people who have knowledge of your dog care. Please list at least one non-relative. 1) Name: __________________________________ Phone Number: ______________________________ Address: _____________________________________________________________________________ Relationship to you: ________________________Email: ______________________________________ How long have you known this person? ____________________________________________________ 2) Name: __________________________________ Phone Number: ______________________________ Address: _____________________________________________________________________________ Relationship to you: _______________________ Email: ______________________________________ How long have you known this person? ____________________________________________________ 3) Name: __________________________________ Phone Number: ______________________________ Address: _____________________________________________________________________________ Relationship to you: _______________________ Email: ______________________________________ How long have you known this person? ____________________________________________________ Please Contact Your Vet and Let Them Know We Will Be Calling. Without Your Consent, Your Vet May Not Release Information To Us. VETS Name: ___________________________________ Phone Number: ________________________ Address: ______________________________________________________________________________ EMERGENCY CONTACT: Please give us the name and phone number for a person to contact in case of an emergency: ___________________________________________________________________________ I hereby certify that all information submitted above is true and correct. I understand that submission of this application does not mean that I will be approved to foster and Second Chance Small Dog Rescue reserves the right to approve or deny any applicant. I authorize Second Chance Small Dog Rescue to verify any and all information in this application and to contact my personal references and vet. I agree to provide any records to Second Chance Small Dog Rescue of all foster dogs in my care. Second Chance Small Dog Rescue reserves the right to reclaim the dog/s if any information is found to be false, incomplete or for any reason at the discretion of Second Chance Small Dog Rescue. I am willing to assume the risks involved with working with dogs that are sometimes frightened and may become aggressive. I agree to assume all risks, which may occur in working with dogs that have come into the care of Second Chance Small Dog Rescue. I understand that dogs can be destructive and a foster dog may cause damage to my property. I agree to hold harmless Second Chance Small Dog Rescue, and/or any representative of Second Chance Small Dog Rescue, for any damage or injury sustained to myself, family members, pets and/or friends as a result of having fostered this dog/s. 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