EmailMe Form - CCRCNY Small Dogs

Date *

MM / DD / YYYY

Applicant's Name *

First Last

Occupation *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

What type of home do you live in? *

- house, condo, apartment…
- own or rent?

Do you rent or own? *

rent

own

If you rent, do you have the landlord's written permission to keep a dog?

yes

no

Landlord's Name

First Last

Landlord's Phone

### - ### - ####

List sex and ages of other adults in home *

List sex and ages of children *

Email *

cell phone # *

### - ### - ####

home phone # *

### - ### - ####

Best # for contact *

Please indicate whether best contact is home or cell#

Driver's License Number *

What are the most important responsibilities of fostering a dog? *

If your foster dog has a potty accident in the house, what would you do? *

If your foster dog growls at you, what would you do? *

Has anyone in the immediate family been bitten by a dog? If yes, please describe the circumstances. *

Do you currently have pets in your home? *

Yes

No

If you have other pets, do they all get along with other dogs? *

Yes

No

If no, please explain how you would manage a foster dog.

Pet 1: Name & species

Please list all pets in the house

Sex, Age, Yr obtained

Breed

Spayed or Neutered

Is this pet vaccinated and on heartworm preventative?

Pet 2: Name & Species

Sex, Age, Yr obtained

Breed

Spayed or Neutered

Is this pet vaccinated and on heartworm preventative?

Please list other pets in the household: name and species; sex, age and year obtained; breed; spayed / neutered; on heartworm preventative.

Name of Vet Clinic *

We try to get at least 3 years of vetting information; if you have been to this vet for less than 3 years, please supply additional vet's contact information.

Phone # of Vet Clinic *

Pets seen by this clinic *

Number of years at this clinic *

I hereby authorize the veterinarian named herein to release information about me or my pet(s) to Chow Chow Rescue of Central New York as necessary to evaluate this application. *

Yes

No

Are all adults in the home in agreement about fostering a new dog? *

Yes

No

Do you have a fenced yard? *

Yes

No

If yes, please describe:

- size of yard, material, height

If you do not have a fence, please explain how your foster dog's potty needs will be met.

How often and for how long will you exercise your foster dog? *

Do you agree that your foster dog must only be exercised on a leash in a safe place? *

Yes

No

How many hours per day will the dog be left unattended? *

Where will the dog be kept? *

Where will the dog sleep? *

During the last two years, have you lost a pet (not through death)? *

Yes

No

If yes, please explain the circumstances:

During the last two years, have any of your pets been poisoned? *

Yes

No

If yes, please explain the circumstances:

During the last two years, have any of your pets been hit by a vehicle? *

Yes

No

If yes, please explain the circumstances:

During the last two years, have any of your pets died from a diease? *

Yes

No

If yes, please explain the circumstances:

Chow Chow Rescue of CNY will provide all medical care, heartworm and parasite preventative. Are you prepared to assume the responsibilities of feeding, bathing, grooming and caring for your rescue, including emotional rehabilitation for a traumatized dog? *

Yes

No

Will you follow all veterinarian instructions provided and administer all prescription medications and HW preventative to your foster? *

Yes

No

Are you prepared to assume the responsibilities of contacting the Chow Chow Rescue of Central New York for any medical emergencies? *

Yes

No

Do you agree that the Chow Chow Rescue of Central New York makes all medical decisions for our rescue dogs? *

Yes

No

Will you let Chow Chow Rescue of Central NY know if you are planning to take your foster out of state for family visits or recreation? *

Yes

No

Though the Chow Chow Rescue of Central NY does not accept vicious dogs into our program, we do not know the histories of some of our rescues. Are you prepared to contact the Chow Chow Rescue of CNY immediately if your foster dog bites anyone or injures another pet? *

Yes

No

Will you walk/exercise the dog regularly? *

Yes

No

Do you agree not to leave the foster dog in your yard when no one is home? *

Yes

No

Will you allow the dog to live indoors? *

Yes

No

Foster parents are encouraged to maintain an 'aunt' or 'uncle' relationship with their foster dog, but occasionally the foster parent and dog bond so completely that adoption is best for all. Do you understand that if you wish to adopt your foster, you must complete the adoption papers and pay the adoption donation? *

Yes

No

As part of our foster approval process, are you willing to allow a CCRCNY representative to visit your home by appointment? *

Yes

No

Comments:

Electronic Signature

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