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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
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Your answer
Last name
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Your answer
Home address
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Your answer
City
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Your answer
State
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Your answer
Zip Code
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Your answer
Name of dog you you are interested in, and indicate whether you want to adopt or foster.
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Your answer
Email address
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Your answer
Home phone
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N/A if you don't have a land line
Your answer
Cell phone number
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Your answer
Do you rent or own your home
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Rent
Own
If you own your home, does your insurance cover dogs?
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Yes
No
Do you live in a
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House
Town home/Condo
Duplex
Trailer/Mobile Home
Apartment
Other:
Landlord's Name and phone number
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If you don't rent, answer N/A
Your answer
How long have you lived at your current address?
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Your answer
If recently moved, how long at your last residence?
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Your answer
What is your occupation
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Your answer
Name and phone number of Contact Person who can always reach you
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Your answer
How did you hear about Lizzy's?
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Lizzy's web site
Facebook
A friend
Petfinder
Other:
Required
Does everyone in the household want a dog?
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Your answer
Do any family members have a handicap or mobility issue we should to be aware of
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Your answer
Number of adults in your household
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Your answer
Number and ages of children in your household
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Your answer
Do you have a fenced yard?
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Yes
No
If you do have a fence, what is the type of fence and the height?
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If no fence, enter N/A
Your answer
Is there anyone at home who might be allergic to dogs?
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Yes
No
List current pets, including age and sex
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Your answer
Tell us about the past 2 or 3 pets (dogs, cats, etc. fish excluded) and why they no longer have them.
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Your answer
Are all your pets spayed or neutered ?
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Yes
No
Have any of your pets had offspring?
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Yes
No
Not sure
N/A
Veterinarian’s Name and phone number
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Your answer
Do you currently use this vet?
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Yes
No
N/A
List three references with phone numbers- at least one should not be a family member
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Your answer
Who will be responsible for dog's care?
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Your answer
Where will dog be during the day?
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Your answer
Where will dog be at night?
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Your answer
Are you familiar with using a crate to train and/or confine dog?
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Yes
No
Do you own a crate?
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Yes
No
Will dog have run of the house?
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No
Yes
Will dog be tied outside or live in the yard?
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Yes
No
How will you discipline dog?
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Your answer
How will you exercise dog and what activities will you share?
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Your answer
What will you do with dog when you go on vacation?
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Your answer
If you move, what will you do with dog?
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Your answer
Are you willing to take responsibility for dog for 10 years or more?
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Yes
No
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)?
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Yes
No
What heartworm preventative will you use?
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Your answer
What steps will you take to control fleas?
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Your answer
If you are unable to care for dog, who will accept responsibility for dog’s care?
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Your answer
What type of vehicle will you transport dog in? If truck, where will dog be in the truck?
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Your answer
I will follow up on dog – would you mind a visit or call?
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yes
no
Why do you want a dog?
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Companion
Guard Dog
Gift
Personal protection
Child's companion
Other:
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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