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.
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First Name *
Last name *
Home address *
City *
State *
Zip Code *
Name of dog you  you are interested in, and  indicate whether you want to adopt or foster. *
Email address *
Home phone *
N/A if you don't have a land line
Cell phone number *
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
How long have you lived at your current address? *
If recently moved, how long at your last residence? *
What is your occupation *
Name and phone number of Contact Person who can always reach you *
How did you hear about Lizzy's? *
Does everyone in the household want a dog? *
Do any family members have a handicap or mobility issue we should to be aware of *
Number of adults in your household *
Number and ages of children in your household *
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
Is there anyone at home who might be allergic to dogs? *
List current pets, including age and sex *
Tell us about the past 2 or 3 pets (dogs, cats, etc.  fish excluded) and why they no longer have them.   *
Are all your pets spayed or neutered ? *
Have any of your pets had offspring? *
Veterinarian’s Name and phone number *
Do you currently use this vet? *
List three references with phone numbers- at least one should not be a family member *
Who will be responsible for dog's care? *
Where will dog be during the day? *
Where will dog be at night? *
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? *
How will you exercise dog and what activities will you share? *
What will you do with dog when you go on vacation? *
If you move, what will you do with dog? *
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? *
What steps will you take to control fleas? *
If you are unable to care for dog, who will accept responsibility for dog’s care? *
What type of vehicle will you transport dog in? If truck, where will dog be in the truck? *
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: *
Add any additional comments here
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