Name of Applicant/Dog's Primary Caregiver:

Address (include city, state, and zip):

Applicant's place of employment:

Applicant's drivers license number and state:

Daytime phone: 

Evening phone: 

Mobile/cell phone: 

Best time to contact:

E-mail: 

Fax: 

Emergency phone (name and number): 

Co-Applicant Name: 

Co-Applicant's place of employment:

Please list any other adults living in household:  

Please list ALL children who live in the household and ages of all children:

Please list names and ages of ANY children who visit you on a regular basis (include any grandchildren or other relatives):

Names, ages, spay/neuter status, species (dog, cat, etc), and breed of ALL pets in your household:

How does your dog(s) react to other dogs (friendly, submissive, growls, etc)? 

Are ALL dogs in your household current on ALL recommended and/or required vaccinations? 
Yes      No
Please list dates of last vaccination:
Rabies:  
DHLPP:  
Other (Bordetella, Lymes):  

Name, address, and phone of current Veterinary Clinic and/or Veterinarian:

May we contact your veterinarian for a reference?  yes    no

Have you ever had a dog diagnosed and/or treated for heartworms?  yes     no
If yes, please explain:

Do you live in:  House          Townhome/Condo           Apartment          Duplex          Trailer         Other    

Do you:  Own     Rent

Do you have the landlors permission to have a dog over 50 lbs.?   yes      no

Landlord's name/address/phone (phone number MUST be provided): 

Do you have a fenced in yard?  yes     no
Type and height of fence: 

Do you allow your dog(s) to run in any unfenced areas?  yes     no
If yes, please explain: 

Is anyone home during the day?  yes     no
If not, where will the dog be kept during the day? 

If no one is home during the day, about how many hours will the dog be left alone? 

Where will the dog be kept during the day? 
During the night? 

Are you familiar with crate training?  yes     no

Do you have a crate available for use with your foster dog?  yes     no

What type of dog training experience do you have? 

Are you aware that your foster dog may be an adult, with an unknown history, and no prior training?  yes     no

Are you aware that your foster dog may chew, dig, bark, jump, or display other undesirable behaviour while in your care?  yes     no

Have you ever taken an obedience course with a dog?  yes     no
Is your dog(s) obedience trained?  yes     no

Are you willing to work with your foster dog in areas such as basic obedience and house training?  yes     no

Have you any experience in introducing new adult dogs into your household?  yes     no
If yes, please describe how this was accomplished:

Are you familiar with the concept of who in the household is Alpha, or top dog?  yes     no
If yes, please describe your understanding of who Alpha is:

Should a disagreement or fight occur between your dog(s) and a foster, how would you handle the situation? What actions would you take to avoid this situation? Please be as detailed as possible in your response.

Are you willing to supervise any children around your foster dog AT ALL TIMES?  yes     no

Please describe the type(s) of foster dogs your are willing to have in your home, i.e. seniors, puppies, adults, male, female, special need dogs (those who may be deaf, blind, recuperating from surgery, or with medical disorders such as epilepsy, low thyroid, etc):

How many dogs are you willing to foster at one time? (On occasion there may be a pair who need to remain together if possible.) 

Is there a preferred activity level for a dog you would want to foster?  

Please describe your level of experience as a dog owner, and provide an honest assessment of your abilities to recognize and deal with any problem behavior a foster dog might exhibit (i.e. barking, growling, possessiveness of food or toys, chewing, digging, jumping, lack of house training, etc.)

Thank you for taking the time to fill out our application, and for your interest in our program.   We will respond to your application as soon as possible; please remember that this organization is staffed totally by volunteers!