2018 Dog Temporary Care Application
Please Note:
1) We are located in Tempe, Arizona and are unable to assist with pets outside of the Phoenix metropolitan area.
2) There is typically a wait list for our Temporary Care Program.
3) We may not be able to help with all of your pets at one time.
4) This is NOT a free program.
5) One application per pet is required.
6) We do not provide transport for pets.

IMPORTANT!!! As part of the Temporary Care Program, we MUST be able to contact you - Please make sure you have access to a reliable form of communication.

Please answer the following questions as thoroughly as possible. Once you have completed this application, please send a photo of your pet to pic@lostourhome.org to help us determine what kennel size they will require. Please include your name, your dog's name, and specify that it is for the Temporary Care Program.

Example: John Doe - Fluffy - Temporary Care Program Picture

We will contact you as soon as possible upon receipt of the application.

First and Last Name *
Your answer
Address where you are currently staying: *
Your answer
Email Address (we communicate PRIMARILY VIA EMAIL): *
Your answer
Best phone number to reach you. IMPORTANT!!! As part of the Temporary Care Program, we MUST be able to contact you - Please make sure you have access to a reliable form of communication: *
Your answer
Please describe the reason you need temporary care for this dog: *
Your answer
Are you currently working with a domestic violence shelter, homeless shelter, or other assisted housing organization? If so, which one(s)? *
Your answer
Are you currently receiving assistance from any of the following: Children's Health Insurance Plan (CHIP), Major VA Disability, Food Stamps, Medicaid, Free Lunch Programs (Public Schools), Social Security Disability (SSD), County Health System Eligibility Program, Special Supplemental Nutrition Program for Women, Infants, Children (WIC), HUD (Section 8 Housing), Supplemental Social Security Income (SSI), Temporary Assistance for Needy Families (TANF, formerly AFDC) *
If you answered Yes to the above question, which one(s)? *
Your answer
How many people are currently living in your household? *
Your answer
Are you a Military Veteran? *
Does your annual income fall under the Annual Income Poverty Guideline? NOTE: This information is for internal use only and will not be used to determine the intake of your animal(s). *
Captionless Image
How many people in your household are age 17 or younger? *
Your answer
Dog's Name (ONLY ONE PET PER APPLICATION): *
Your answer
Dog's Age: *
Your answer
Dog's Sex: *
Dog's Breed: *
Your answer
How much does your dog weigh (approximately) *
Your answer
How long have you had your dog? *
Your answer
Does your dog have a history of biting or aggression? Please describe. *
Your answer
How does your dog behave around other dogs? *
Your answer
How does your dog behave around cats? *
Your answer
How does your dog behave around children? *
Your answer
Has your dog ever lived with other dogs, cats, or children? Please provide details. *
Your answer
What is your dog's activity level? *
Where does your dog spend most of its time? *
Is your dog housebroken? *
Is the dog familiar with a dog door?
Does your dog know any commands? If so, which ones? *
Your answer
Does your dog escape the home or yard? If so, please specify how high of a fence they can jump. *
Your answer
Does your dog have any destructive behaviors? Examples include chewing, scratching, biting, inappropriate urination/defecation, etc. *
Your answer
How does your dog act when left alone? Does he/she bark, howl, cry, sleep, chew, etc.? *
Your answer
Is your dog spayed or neutered? *
What vaccinations has your dog received? YOU MUST PROVIDE PROOF OF VACCINATIONS UPON INTAKE. *
Required
Does your dog have any medical issues, allergies, or special dietary needs? *
Your answer
How long will you need us to care for your dog?
Your answer
Additional Comments (please use this space to provide us with any information that will make caring for your dog easier): *
Your answer
I understand that I will be contacted as soon as possible VIA EMAIL with next steps to take if we are able to care for your pet. If we are unable to care for your pet, we will provide you with alternative resources. *
I understand that the Temporary Care Program is NOT A FREE PROGRAM. A Lost Our Home Representative will discuss cost and payment plans with me if they are able to care for my pet. *
I understand that Lost Our Home Pet Rescue is unable to hold spaces due to the high demand of the program. It is important that I respond to them as soon as possible when they reach out to me. *
I understand that my pet must pass a behavioral evaluation prior to acceptance into the Temporary Care Program. *
I understand that Lost Our Home and our representatives and employees will not be liable or responsible for any lost, stolen, or damaged personal property belonging either to the pet parent or the animal. *
I understand and agree to assume all risks involved on behalf of or in connection with Lost Our Home Pet Foundation Inc. I agree to hold Lost Our Home Pet Foundation Inc., it’s successor organizations, any representatives thereof or any third parties harmless for any injury(s), loss or damages which I might sustain during my time at the shelter. This waiver includes myself, all of my family members and descendants forever from seeking any legal action whatsoever against Lost Our Home Pet Foundation Inc. its successor organizations, any representatives thereof or any third parties. *
I understand that my dog(s) may go into a foster home with a Lost Our Home foster volunteer. I will have access to visit my dog(s) by setting up an appointment with the foster volunteer. *
STAFF ONLY - Reason for TCP
STAFF ONLY - Voucher used? If yes, enter Voucher Number
Your answer
STAFF ONLY: POLICE DROP-OFF?
STAFF ONLY: IF YES, WHAT CITY?
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