Lizzy's Animal Hospice Adopt- Foster Form
Please fill in the form below to let us know if you would like to either adopt or foster a senior. We look forward to talking to you.
Please be sure to indicate what you would like to do in the "adopt or foster" box . Use the comment box at the end of the form to add anything you would like us to know.
First Name *
Your answer
Last name *
Your answer
Home address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Name of dog you want to adopt or foster *
Your answer
Email address *
Your answer
Home phone *
N/A if you don't have a land line
Your answer
Cell phone number *
Your answer
Do you rent or own your home *
If you own your home, does your insurance cover dogs? *
Do you live in a *
Landlord's Name and phone number *
If you don't rent, answer N/A
Your answer
How long have you lived at your current address? *
Your answer
If recently moved, how long at your last residence? *
Your answer
Name and phone number of Contact Person who can always reach you *
Your answer
Does everyone in the household want a dog? *
Your answer
Number of adults in your household *
Your answer
Number and ages of children in your household *
Your answer
Do you have a fenced yard? *
If you do have a fence, what is the type of fence and the height? *
If no fence, enter N/A
Your answer
Is there anyone at home who might be allergic to dogs? *
List current pets, including age and sex *
Your answer
Are all your pets spayed or neutered ? *
Have any of your pets had offspring? *
Veterinarian’s Name and phone number *
Your answer
Do you currently use this vet? *
List three references with phone numbers- at least one should not be a family member *
Your answer
Who will be responsible for dog's care? *
Your answer
Where will dog be during the day? *
Your answer
Where will dog be at night? *
Your answer
Are you familiar with using a crate to train and/or confine dog? *
Do you own a crate? *
Will dog have run of the house? *
Will dog be tied outside or live in the yard? *
How will you discipline dog? *
Your answer
How will you exercise dog and what activities will you share? *
Your answer
What will you do with dog when you go on vacation? *
Your answer
If you move, what will you do with dog? *
Your answer
Are you willing to take responsibility for dog for 10 years or more? *
Are you aware of the cost of caring for a dog or older dog each year (vet care, licensing, food, toys, training, elder care, etc. minimum $500)? *
What heartworm preventative will you use? *
Your answer
What steps will you take to control fleas? *
Your answer
If you are unable to care for dog, who will accept responsibility for dog’s care? *
Your answer
What type of vehicle will you transport dog in? If truck, where will dog be in the truck? *
Your answer
I will follow up on dog – would you mind a visit or call? *
Why do you want a dog? *
Please explain your idea of dog that would best fit in your home, including age and temperament: *
Your answer
Add any additional comments here
Your answer
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