Hannas Haven Foster Application 2

Name *

Last *

Email *

Date *

Address *

City *

Cell Number *

Home Phone Number *

Name(s) and age(s) of all household members *

Are you ready to foster immediately? If NO when? *

Who will be the PRIMARY caregiver? *

Will you and your family consent to a home visit/check prior and during the fostering period? *

YES

NO

Do you rent or own your property? *

If you rent please provide LANDLORDS name and number *

What type of residents do you live in? (House, Condo, Apartment, Acreage etc.) *

Age preference of Dog/Puppy *

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. *

How much time are you able to spend with the animal(s) and who will be home to supervise? *

Do you have a SEPERATE room or QUIET room where the foster animal can be separated from your own pets/animals? *

YES

NO

Where will the animal(s) sleep? *

Inside

Outside

Do you have any other animals? *

YES

NO

Is your pet spayed or neutered? *

YES

NO

What breed are your current pets? *

Who is your veterinarian? *

Has any dog in your home had parvovirus or distemper? *

YES

NO

Does anyone in the home have allergies to Dogs? *

YES

NO

What provisions have been made for outdoor shelter or setups? *

Where will the animal(s) be kept during times of NON-SUPERVISION? *

Why would you like to participate in this program? *

Personal References: Please list the name, relationship and phone numbers of 2 references *

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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