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Name
*
Last
*
Email
*
Date
*
Address
*
City
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Cell Number
*
Home Phone Number
*
Name(s) and age(s) of all household members
*
Are you ready to foster immediately? If NO when?
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Who will be the PRIMARY caregiver?
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Will you and your family consent to a home visit/check prior and during the fostering period?
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YES
NO
Do you rent or own your property?
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If you rent please provide LANDLORDS name and number
*
What type of residents do you live in? (House, Condo, Apartment, Acreage etc.)
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Age preference of Dog/Puppy
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Newborn/Mom
Baby (8 weeks +)
Young dog (5 months +)
Adult Dog 1 years +)
Senior (8 years + )
Number of ADULTS and CHILDREN in your home
*
Please describe your knowledge, experience and abilities in the care of training dogs/puppies to assist us in identifying the proper placement of the animal(s) that will benefit through our foster program.
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How much time are you able to spend with the animal(s) and who will be home to supervise?
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Do you have a SEPERATE room or QUIET room where the foster animal can be separated from your own pets/animals?
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YES
NO
Where will the animal(s) sleep?
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Inside
Outside
Do you have any other animals?
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YES
NO
Is your pet spayed or neutered?
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YES
NO
What breed are your current pets?
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Who is your veterinarian?
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Has any dog in your home had parvovirus or distemper?
*
YES
NO
Does anyone in the home have allergies to Dogs?
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YES
NO
What provisions have been made for outdoor shelter or setups?
*
Where will the animal(s) be kept during times of NON-SUPERVISION?
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Why would you like to participate in this program?
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Personal References: Please list the name, relationship and phone numbers of 2 references
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I understand that as a foster home and family I accept responsibility for our foster dog(s) and I release HANNAS HAVEN DOG RESCUE from any and all liability or damage, injury, illness to my family, pets, property, or myself while I am volunteering as a foster home. (Signature)
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