RCHS FOSTER Application for Dog(s)

Full Name*

First NameLast Name

Age

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number - Home*

Area CodePhone Number

Phone Number - Cellular

Area CodePhone Number

Place of Employment*

Phone Number - Work

Area CodePhone Number

Do you live in a:*

Do you:*

OwnRentLive with ParentsOther

If Renting: Please indicate landlord contact information

How long have you lived at your current address?*

Household Setting

RuralCity

Describe the Activity Level in your Home*

Busy/NoisyModerate Comings/GoingsQuiet with Occasional Guests

Please List all People Living in the Household (Include Name, Relationship, Gender and Age)*

Are all members of your family agreeable to Fostering a Dog?*

YesNo

How would you describe your level of experience with dogs? Check all that apply*

Never had a dogHad childhood dogHave had one or more dogs as an adultHave experience working with on-going medical problems with a personal dogHave experience working at a boarding kennel/resort/pet sitting service, etc.Have experience working with behavioral problems with a personal dogHave experience working in a veterinary hospitalAm a professional dog trainerHave previous foster/rescue experience

Please List any Pets you have Currently or Within the past 10 years (Please include Name, Breed, Age, Spayed/Neutered, Sex, Living/Deceased)*

Do we have permission to call your veterinarian for a reference check? (Please authorize vet to speak with us)*

YesNo

Veterinarian Name*

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

Where will the dog spend the day?*

Where will the dog spend the night?*

Are you willing to use a crate for a dog if recommended?*

YesNo

Do you have a crate or would you need to borrow one from the shelter?*

I have a crateI would need to borrow a crateI do not wish to use a crate

Do you have a fenced yard?*

YesNoPartial

If fenced, please give details on height, material, # of gates, are gates locked or lockable?

Please read the following carefully:

You will be expected to keep the animal safe and secure, return it to RCHS when requested to do so, and not promise the animal to anyone, or imply that you have the authority to approve a potential adoption. RCHS retains ownership of all animals placed in foster care, and will make all decisions regarding the adoption & placement of the animals fostered.

The foster parent is responsible for transporting the animal(s) to and from RCHS for veterinary appointments, surgery, vaccinations, etc.

I have read and understand the statements above. I certify that all the information contained in this application is true and correct. I understand that although RCHS takes reasonable care to screen animals for foster care placement, it makes no guarantees relating to the animals’ health, behavior or actions. I understand that I receive foster care animals at my own risk and can decline to accept any animal for which RCHS has asked me to provide care. I acknowledge that RCHS is not responsible for any property damage or personal injury suffered by me, members of my household, including my own animals, or any third parties during a foster placement, and I assume liability to provide adequate controls to prevent such damage or injury.

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

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MonthDayYearHourMinutesAM/PM Option

Your name*

Co-Applicant name (if applicable)

Ritchie County Humane Society Foster Application