Foster's Name

Foster's Phone Number

Dog's Name

Dog's Description and Sex

Your Name

Name of Spouse/Partner

Street Address

City, State, Zip

Phone Number

Cell Number

Date of Birth

Driver's License Number

Email Address

Number of Adults in your Home

Number of Children in your Home

Ages of the Children

Occupation

Type of Dwelling

Do you own or rent?
Own Rent

Landlord's Name and Phone Number

Veterinarian/Clinic Name and Phone Number

Name(s) of Pets Taken There

Do you agree to spay or neuter?
Yes No

Is this dog a gift?
Yes No

Will the dog be an indoor or outdoor dog?

Does your home have a yard?
Yes No

Approximate area of yard:

Does your yard have a fence?
Yes No

Height of fence:

Where would your dog be kept during the day?

Where would your dog be kept during the night?

How many hours per day would your dog be left alone?

Is an adult home during the day?
Yes No

Primary reason for adopting this pet:

Is anyone in the household allergic to animals?
Yes No

What type of dog are you looking for?

What attracted you to this dog?

Do you have any other pets in the home?
Yes No

Number of Cats:

Number of Dogs:

How many of them are spayed or neutered:

Have you had pets in the past?
Yes No

Please list any pets you have had in the past. Please include how the pet was
obtained, how long he/she was kept, and what happened to the pet:

Animals are as individual as people. Are you willing to spend the time and effort to help this dog adjust to home/lifestyle?
Yes No

How much time would you be willing to spend?

Under what circumstances would you not keep this dog?

If the dog became destructive, what would you do?

Would you permit an on-site premise check?
Yes No