Today's Date
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Which dog are you interested in (For FOSTER: please put "any" unless there's a specific dog you're considering.)?
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How did you hear about the dog you are interested in? (e.g. Facebook, Petfinder)
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PERSONAL
First name
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Last Name
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Date of Birth (you must be 21+ years of age)
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Address
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City
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State
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AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip Code
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Phone Number(s)
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Email Address
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Occupation
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Employer
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Who will be the dog’s primary caregiver?
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List legal names, birthdates, and relationships of everyone else in your household. Note: We do background checks on all adults in the household so dates of birth are imperative. If no one else, please put N/A.
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Occupation and Employer for other adults in the home listed above: If no other adults please put NA
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RESIDENCE
If rent, provide landlord's full name AND phone number
If yes, please describe what your fence is. If no fence, please put NA:
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If your yard is NOT bounded by a fence, how do you plan to keep the dog safe while outdoors? If you have a fence, please put NA:
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PET HISTORY
If yes, please describe ALL of the following: Species (Cat,Dog etc), Name, Age, Weight, Breed, Gender. If no pets, please put NA:
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If you answered NO to monthly heartworm, monthly flea and tick, current on vaccinations, or having a negative heartworm test - PLEASE EXPLAIN and answer when are they due for these tests/vaccinations: If you answered YES to all of those, please put N/A:
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If you ever surrendered an animal to a shelter or re-homed any animal that you have owned, please explain the circumstances.
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List any pets you have had in the past 10 years that you have not already listed above (name, breed):
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DOG INFO
What you are looking for in a dog?
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Where will the dog be kept during the day?
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Where will the dog be kept at night?
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What is the longest the dog would be alone during a typical 24-hour period?
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What brand of food would you feed the dog?
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How do you plan to give the dog daily exercise?
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Dogs transitioning to a new home may have an adjustment period that could mean accidents, chewing or other behaviors. How would you handle this?
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Additional information you think would be helpful for us to know:
First Non-Family/Non-Significant Other Reference with Phone Number (Name, relationship, phone)
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Second Non-Family/Non-Significant Other Reference with Phone Number (Name, relationship, phone)
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OTHER REFERENCE
Name and phone of veterinarian (If you do not currently have a veterinarian due to not having pets, please put NA - No current pet)s
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FOR FOSTERS ONLY
CONSENT / RELEASE
FOR OFFICIAL USE ONLY License #10317
Date Recieved
Date Contacted
DF Rep