Name *

Address

City

State

Zip Code

Phone Number

Email Address

Preferred Contact Method

I am 21 years of age or older *

Do you rent or own *

If renting, what is the policy on allowing pets

Is there a deposit fee for pets

Is there a weight or breed restriction for pets

May we contact your landlord

Landlord’s Name

Landlord’s Phone No.

Do you have a fenced in yard

If yes, what type and how high

Do you have children in your home

If yes, how many and the age of each child

Do your children understand the responsibilities of caring for animals

Do you currently own any pets

If no, have you owned any pets in the last four year

Please list the name, breed and age of your current or pets in the last 4 years

Are the vaccinations current for your pets

Date of Expiration

Are your pets on heartworm preventative

Name of the preventative

Are your pets spayed/neutered

If no, please explain why

May we contact your Veterinarian

Veterinarian Name

Veterinarin’s Phone Number

Have you ever fostered a dog before?

If yes, for what rescue group?

Where will you keep the dog while you are away from home?

How many hours per day will the dog be alone?

Do you have a crate to use?

Can you foster the dog until it is adopted?

If no, how long can you foster the dog?

Can a potential adopted come to your home to meet the dog?

Are you willing to do home checks for potential adopters?

Why do you want to foster a dog?