* 1. Are your current pets neutered/spayed? Yes No
* 2. Applicant's full name:
* 3. Co-applicant's full name:
* 4. E-mail address: (Please double-check this)
* 5. Address:
* 6. City:
* 7. State:
* 8. Zip Code:
* 9. Home phone no: (1- xxx - xxx - xxxx)
*10. Cell phone no: (1 - xxx - xxx - xxxx)
*11. Applicant's age:
*12. Co-applicant's age:
*13. Why do you want to foster?

*14. Describe the type of dog you would like to foster (large, medium, small, length of hair, age, etc.)

*15. Do you have transportation? Yes No
*16. Do you prefer and inside dog, an outside dog or an inside/outside dog? Inside Outside Inside/outside
*17. Would you consider fostering a special needs dog? Yes No Maybe
*18. Would you consider fostering a dog that is not housebroken? Yes No Maybe
*19. Will you have time to teach as foster dog some basic manners? Yes No Maybe
*20. What are your thoughts on the use of crate training your foster dog?

*21. Applicant's occupation:
*22. Co-applicant's occupation:
*23. Applicant's place of employment and phone no.:
  How long have you worked here?   If you've worked here less than a year, please explain.

*24. Co-applicant's place of employment and phone no.:   How long have you worked here?   If you've worked here less than a year, please explain.

*25. If you work, is anyone at home while you are working? Yes No   If yes, who?   Will this person be responsible for the dog? Yes No
*26. Do you travel frequently? Yes No
*27. Please specify what type of home you live in: Single Family
Mobile home Duplex Condo Townhouse Other
*28. Do you rent or own? Own Rent  If you rent, please provide the name and telephone number of your landlord:   If renting, please attach proof (copy of your lease) that states that your property manager approves of you having a pet in your residence and that it does not violate your rental agreement.
*29. How long have you lived at this address?
*30. How long at your previous address?
*31. Please list all people currently living at this residence, their relationship to the applicant and their ages:
  If there are children in your household, have they been taught to respect animals? Yes No   Is eveyone in your household agreeable to this undertaking, and will they cooperate with your rescue efforts after reviewing the Rescue and Adoption Overview and Guidelines? Yes No
*32. Does anyone in your household have allergies to animals? Yes No
*33. Do you have a pool or hot tub? Yes No   If you do, is it fenced or covered so that a pet CANNOT get to it? Yes No   Explain, if necessary.
*34. Do you have a completely fenced area on your property? Yes No   If No, please tell us how you will address the dog's exercise and bathroom needs, etc.

*35. How many hours each day will your dog be alone? Weekdays:
Weekends: Evenings:
*36. Where will your foster dog be kept during the day (loose indoors, crate, basement, laundry room, kitchen, other confined room, fenced yard, chained outside, dog run, outside kennel run, on lead attached outside, loose oudoors, garage, dog house, etc.)? Please be specific!

*37. Where will your foster dog sleep at night? Again, be specific.

*38. Who will be responsible for feeding this dog?
*39. Who will be responsible for housebreaking this dog?   How much experience does this person have in housebreaking and training a dog? Explain.

*40. How would you handle housetraining? Explain.

*41. Who will care for the dog in the event you are ill, on vacation or otherwise incapacitated?
*42. Have you, as an ADULT, owned a dog before? Yes No   If the dog is no longer with you, please provide a brief explanation of where it is now.

*43. Have you ever had an animal die at an early age? Yes No   If yes, please explain.

*44. Have you ever given an animal to another person, rescue or shelter? Yes No   If yes, please explain.

*45. Please list below any pets who currently live in your house. Include their name, breed, sex, age, years owned and whether or not they are spayed or neutered.   Are these pets up to date on shots, heartworm preventative, veterinary care, etc. Yes No   If not, please specify which ones and why not.

VET REFERENCE: WE REQUIRE THAT YOU PROVIDE THE NAME OF YOUR CURRENT VET, OR IF YOU HAVE NO ANIMALS AT THIS TIME, THE NAME OF A VET YOU HAVE USED IN THE RECENT PAST. WE WILL CALL THIS VET TO CHECK ON YOUR PREVIOUS CARE OF ANIMALS.
*46. Name of vet's office:
*47. Vet's phone number:
*48. Vet's full address including state and zipcode:
*49. Approximate date of last visit:
*50. Reason for last visit:
*51. What name are vet records listed under?
*52. Groomer reference: If you have a groomer you have used before, please list the name and phone number here:
Personal References (not family members):
*53. (1) Name and phone number:
*54. (2) Name and phone number:
*55. (3) Name and phone number:
*56. How did you hear about Pekes and Pals? Petfinder Adopt-a-Pet Pets911 petadoptions.org News Press online Other   Referred by:
*57. Home visits are required by rescue. Is this acceptable to you? Yes No   What days and times are you available?

I understand that this organization cannot guarantee the health, temperament or training of the foster dog, and I hereby release Pekes and Pals Canine Resuce, Inc. from all liability once the dog is in my possession.

Signature of applicant: _________________________________ Date: ______________