If you are a human and are seeing this field, please leave it blank. Name of Dog: First Name Last Name Home Phone Work Phone Cell Phone Fax Email Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code How long have you lived here: Other Adults or Children (ages) living with you: Hours spent at work per day (Away from the home): Do you Own or Rent (If renting, a letter from your landlord authorizing your housing a large dog will be necessary prior to fostering.): If you rent, what is your Landlord's Name: Landlord's Address & Phone Number: If renting do you know if there is a size/weight limitation? What is it? Approximate Square Footage of Home: Do you have a yard? What size yard: Is your yard fenced? Type of fence, height of fence, lowest point of fence? Do you consider your yard to be secure for a dog? Do you currently have any dogs? If Yes, please list their breed, age, sex and if they are spay/neutered: Do you currently have any other animals? If Yes, please list their species, breed, age, sex and if they are fixed & vaccinated Do your animals have any physical issues? Do your animals have any behavioral issues? Do your animals get along with (other) dogs? If you have dogs are they :Inside Only/Outside Only/Inside and Outside: Where will the dog be when it is alone? How many hours alone? What rooms are off limits to the dog? Do you have a doggie door? What, if any, behavioral issues have you dealt with in the past? Have you ever had any of your own dogs get into a fight? If yes, explain: How do you normally walk your dog? On leash, off leash: Please rate your experience with dogs (1 inexperienced - 10 experienced): Who will be the primary caregiver of the dog: Please list 2 reference names with phone numbers: I certify that the information contained in this application is true and correct and I understand that prior to the placement of a dog in my home, I will agree to a home visit by someone from the organization. I understand that this application does not qualify as an adoption agreement, and that an adoption contract must be signed in order to finalize the adoption process. Please enter your full name: Date:
