| Name: |
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| Address: |
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| City/State/Zip: |
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| Phone: |
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| E-mail: |
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| Name and ages of anyone living inside the home other than yourself: |
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| How long have you lived there: |
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| Do you own or rent: |
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| Do you live in a house, condo, apartment, or townhouse: |
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| If you have a landlord or an association please include Name and Number: |
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| Name of home owners or renters insurance company: |
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| Employer: |
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| Work Phone: |
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| Do you have a fenced yard? If yes, how tall and what type of fence: |
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| If no, how will the dog go outside: |
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| How do you plan on exercising the dog and how often: |
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| Would you be willing to attend obedience class with your foster dog: |
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| Will the dog live inside or outside: |
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| Where will the dog sleep: |
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| Please explain a typical day in the life of the foster dog: |
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| How many hours a day will the dog be alone: |
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| Please list any current pets: |
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| Are they spayed/neutered: |
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| Are they up to date on vaccines (DHPP and Rabies): |
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| Have they been to obedience class? If yes, where: |
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| Please list any previous pets: |
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| Would you return the dog? If yes, why: |
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| Reference (name, phone, relationship): |
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| Reference (name, phone, relationship): |
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| Vet Reference (name and phone): |
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| Gender preferred: |
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| Age preferred: |
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| How did you find us: |
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| Signature: |
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