First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County

Email*

Home Phone

Work Phone
x

Cell Phone*

Alt Email

Text/Pager Email

Best number to reach you: (home, cell, work, other)*

Best time to contact:*

Emergency phone (give name & phone):*

Please list any other adults living in the household:*

Please list names and ages of ANY children who either live with you or visit you regularly (include any grandchildren or other relatives):*

Please provide the Names, ages, spay/neuter status, species (dog, cat, etc.), & breed of ALL pets in your household:

Pet 1: Pets Name, Age, Spay/Neuter Status, Species (dog, cat, etc) & breed:*

Pet 2: Pets Name, Age, Spay/Neuter Status, Species (dog, cat, etc) & breed:

Pet 3: Pets Name, Age, Spay/Neuter Status, Species (dog, cat, etc) & breed:

Pet 4: Pets Name, Age, Spay/Neuter Status, Species (dog, cat, etc) & breed:

Pet 5: Pets Name, Age, Spay/Neuter Status, Species (dog, cat, etc) & breed:

How does your dog(s) react to other dogs? (Friendly, submissive, growls, etc.):

Are ALL dogs in your household current on ALL recommended and/or required vaccinations?*
Choose one: Yes No Not Applicable

Please list the date of last vaccination: Rabies*

Please list the date of last vaccination: DHLPP*

Please list the date of last vaccination: Other (Bordetella, Lymes)*

Are ALL dogs in your household spayed/neutered?*
Choose one: Yes No Not Applicable

Name, address, & phone of current Veterinary Clinic and/or Veterinarian:*

Have you ever had a dog diagnosed and/or treated for heartworms?*
Choose one: Yes No

If yes, please explain:

Do you own/rent?*
Choose one: Rent Own

Live in*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing Trailer Other

Residence other:

Do you have the landlord's permission to have a dog?
Choose one: Yes No

Landlord's name, address, & phone number:

Do you have a fenced yard?*
Choose one: Yes No

What type of fence and height of the fence?*

Do you allow your dog(s) to run in any unfenced areas?
Choose one: Yes No

If yes, please explain:

Is anyone home during the day?*
Choose one: Yes No

If not, where will the dog be kept during the day?

If no one will be home during the day, how many hours will the dog be left alone?

Where will the dog be kept during the day?*

During the night?*

Are you familiar with crate training?*
Choose one: Yes No

Do you have a crate available for use with your foster dog?*
Choose one: Yes No

What type of dog training experience do you have?*

Are you aware that your foster dog may be an adult with an unknown history and no prior training.*
Choose one: Yes No

Are you aware that your foster dog may chew, dig, bark, jump, or display other undesirable behaviors while in your care?*
Choose one: Yes No

Are you willing to take your foster dog to the vet designated by Texas ACR for routine vaccinations and other medical requirements?*
Choose one: Yes No

Are you willing to work with your foster dog in areas such as basic obedience and house training?*
Choose one: Yes No

Have you had any experience in introducing new adult dogs into your household?*
Choose one: Yes No

Are you willing to supervise any children around your foster dog AT ALL TIMES?*
Choose one: Yes No

Please describe the type(s) of foster dogs you are willing to have in your home, i.e., seniors, puppies, adults, male, female, special need dogs (those who may be deaf, blind, recuperating from surgery, or with medical disorders such as epilepsy, low thyroid, etc.):*

How many dogs are you willing to foster at one time? (on occasion there may be a pair who need to remain together if possible):*

Is there a preferred activity level for a dog you would want to foster?*