General Information:

Name:

Email Address:

Referred By:

Home Address:

City:

State: Select AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY       Zip:     

Home Phone:

Cell Phone:

Age:

Marital Status:

Occupation:

Employer:

Work Address:

City:

State: Select AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY       Zip:      Work Phone:

Spouse/Partner Occupation:

Who You're Looking For:

What age of dog would you like to foster? (please select as many as apply)

Puppy Young Adult Senior No Preference

Male or female?

Male Female No Preference

What type of dog are you hoping to foster?

What characteristics are important to you?

What do you most like about dogs?

What do you like least about having a dog?

Who will be the primary caregiver of the dog?

Are you willing to accept a dog with behavior problems who requires special training? Click here to learn what this means.

Yes No Not Sure

Are you willing to accept a dog with special needs? Click here to learn what this means.

Yes No Not Sure

Are you willing to accept a dog with a history of neglect/abuse who needs extra love and attention? Click here to learn what this means.

Yes No Not Sure

Would you be willing to foster more than one dog?

Yes No Not Sure

Would you be willing to foster a bonded pair?

Yes No Not Sure

About Your Home:

Type of Residence:

Select House Apartment Townhouse Condominium Mobile Home

How long have you lived here?

Do you Rent or Own?

Select Rent Own home Other

Do you plan to move/relocate within the next year?

If you rent/lease, the following information is required so we can verify that you are allowed pets.

If you rent, are you allowed pets?

Yes No

Does your rental agreement specify a size restriction?

Yes No

Landlord's Name:

Landlord's Phone:

Landlord's Address:

ABOUT YOUR HOUSEHOLD:

Do you have children under the age of 10 who are frequent visitors (such as grandchildren, neighbors, etc.)?

Yes No

If yes, please explain:

Is anyone in your home allergic to dogs? If so, please explain.

Do you have a backyard or deck?

Backyard Deck Both Neither

If yes, is it enclosed?

Select Yes No

If you have a pool, is it fenced?

Yes No

If you have a dog run, is it secure?

Yes No

If your yard is fenced, please describe the fence:

How will your foster dog relieve/exercise himself?

What is your household activity level?

Quiet Active Very active

Please explain

Do all adults work full time?

Yes No

How many hours a day will the foster dog be alone?

Select 3 or less 3-6 6-8 more than 8

Do you travel often?

Yes No

Who will care for your foster dog when you travel?

Approximately how many hours a day will your foster dog be alone?

Where will your foster dog be kept when he/she is alone?

Where will your foster dog spend the day?

How much time will you have to spend with your foster dog?

Where will your foster dog sleep at night?

Who will walk your new foster dog? And how often?

Is a home visit OK?

Yes No

If you became ill or temporarily disabled, is there someone who can help care for your foster dog?

History of Pet Ownership:

Please list any dog(s) you have owned in the past and explain what happened to him/her.

Have you ever given an animal to another person, rescue, or shelter? If yes, please explain?

References

Please provide names, relationship and phone numbers of 2 people, plus groomer/pet sitter and veterinarian. At least one cannot be a relative.

Reference 1:

Reference 2:

Groomer or Pet Sitter:

Vet's Name:

Vet's Location:

Vet's Phone:

Vet records are under the name of:

If you have an additional vet(s), please list the additional information:

Please provide any other information that may be helpful for us to know when reviewing your application

I agree to foster an animal and will follow all relevant procedures and guidelines regarding the animal as stated in the Shih Tzus & Furbabies Contract. If the animal cannot be kept by the Foster Family, the Foster Family shall notify a Rescue Coordinator immediately. The animal shall not be sold, abandoned, relinquished to a pound or shelter or to a Rescue group other than Shih Tzus & Furbabies, transferred, or given to any individual, or to any retail or wholesale establishment.


All of the information I have provided is true and complete to the best of my knowledge. Should a pet be placed with me it will reside in my home as a pet. I agree to provide the dog with adequate food, water, shelter, affection and medical care.

Signature of Applicant

Date of Application

Thank you for taking the time to complete this questionnaire. Your answers will permit us to more effectively match available dogs' needs with your lifestyle and requirements.

Our E-mail address:info@shihtzusandfurbabies.com