Contact Information

Name

Address

Address2

City

State

ZIP

Phone

Email

Best Time to Contact

Emergency Contact (Give Name and Phone)

Co-Applicant's Name (If Applicable)

Please list any other adults living in household

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

Please list breed(s) of all your pets, and names, ages, spay/neuter status, species (dog, cat, etc.),currently 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?

Date of last Rabies vaccination

Date of last DHLPP vaccination

Other vaccinations and dates

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

Will/does this vet or another vet in your area work with rescue organizations and give them discounted prices for services rendered?

What Heartworm preventative are you currently administering to your pets?

Have you ever had a dog diagnosed and/or treated for heartworms?

If yes, please explain

Please list two references including their names, addresses, and phone numbers

May we have your permission to check your veterinarian and personal references?

Describe your home

Do you own or rent?

If renting, do you have the landlord’s permission to have a dog over 50 lbs.?

Landlord’s name, address, & phone number

Do you have a fenced yard?

What type of fencing, and height of fence?

Do you allow your dog(s) to run in any unfenced areas?

If yes, please explain

Is anyone home during the day?

Where will the dog be kept during the day?

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

Are you familiar with crate training?

Do you have a crate available for use with your foster dog?

Would you like to borrow a crate from Heartland?

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?

Are you aware that your foster dog may chew, dig, bark, jump, or display other undesirable behaviors while in your care?

Have you ever taken an obedience course with a dog?

Is your dog(s) obedience trained?

Are you familiar with the concept of who in the household is Alpha, or top dog?

If yes, please describe your understanding of who Alpha is:

Should a disagreement or fight occur between your own 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?

Please describe the type(s) of foster dogs you 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 behaviors a foster dog might exhibit (i.e. barking, growling, possessiveness of food or toys, chewing, digging, jumping, lack of house training, etc.)

Applicant E-Signature

Date

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