First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County

Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

Applicant Age*
Choose one: 18-20 21-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94

Co-Applicant's Name and Age

Please select the age range for any co-applicant.
Choose one: 18-20 21-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94

How many people currently live in the home? Please include the names and ages of everyone living in the home (for any minors, names are not required but we do require their ages). *

We have a number of areas within the rescue that can always use assistance. Please indicate the specific areas below or if an area is not listed you can provide details in the "other" section.

Fostering: short term*

Fostering: long-term*

Other (please provide additional information)

Summarize any special skills or qualifications that you may have acquired from employment, previous volunteer work, or through other activities, including hobbies and sports.*

Summarize your previous volunteer experience.*

When are you available to start volunteering?

Do you (the applicant) own or rent your home? (We do verify property ownership which means that the property must be in your name.) If you do not own the property, we must be able to contact the property owner for their approval.*
Choose one: Rent Own

If you rent, please enter your landlord's name and phone number

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Does your current lease or homeowners’ association have any covenants or restrictions on pet ownership?*

Does your city or town have any restrictions on the number of dogs you can have?*

If you answered yes to the previous question(s), please elaborate:

Do you currently have your yard, or a portion of your yard, securely enclosed with a physical fence?*
Choose one: Yes No

What type of fence do you currently have at your home or use with your current dog? NOTE: PLEASE READ OVER OUR FENCING REQUIREMENTS UNDER THE ADOPTION INFO TAB ON OUR WEBSITE.
Choose one: Chain Link Invisible Other Privacy Split Rail Wrought Iron

If you have a dog run, is it secure?*

Many times we take in dogs from shelters, commercial breeders or with an unknown history that need to be isolated for up to 14 days. Do you have an area for dogs that may need a quarantine period?

Are you willing to foster dogs with special medical needs?*

Are you willing to foster dogs with a history of abuse/neglect that may need extra love and attention?*

Are you willing to foster dogs with behavioral problems that may require special training?*

Are you willing to foster puppy mill dogs and socialize them?*

Would you consider fostering a Shih Tzu mix or another breed?*

How long would you be willing to foster a dog?*

Do you have any restrictions on fostering a dog?*

CURRENT PETS: What animals currently live in the household? (Please list type of animal, NAME, sex, altered or not, age and how long you have owned them, and are they inside or outside animals) NOTE: If you list any pets in this section, please be sure to include their NAME and the veterinarian that provides their care. If you do not provide this information, your application will be delayed. *

PRIOR PETS: If you have had animals in the past 10 years that are no longer living or living in your home, please list type of animal, NAME, sex, altered or not, age and how long you owned them, were they inside or outside animals, and why do you no longer own? NOTE: If you list any pets in this section, please be sure to include their NAME and the veterinarian that provided their care. If you do not provide this information, your application will be delayed. *

What is the name and telephone number of the dog's veterinarian?*

If you have a groomer that you have used in the past, please include their name and number.*

List three personal references, FIRST AND LAST NAME (who are not family members or listed as a reference in another portion of this application) with their contact information - either telephone numbers, email addresses or both. WE DO REQUIRE 3 PERSONAL REFERENCES AND THEIR CONTACT INFORMATION IN THIS SECTION OR WE CANNOT PROCESS YOUR APPLICATION.*

I understand that I cannot adopt my first foster.

I certify that the information entered on this applicant is true. Enter your name and date