Today's Date
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Which dog are you interested in (For fostering: 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)
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 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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RESIDENCE
If rent, provide landlord's contact info.
If yes, please describe (Note: homes with electric/underground fences will not be considered)
If your yard is NOT bounded by a fence, how do you plan to keep the dog safe while outdoors?
PET HISTORY
If yes, please describe (name, age, breed, gender)
If you have cats, please describe (name, age and gender).
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 Reference with Phone Number (Name, relationship, phone)
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Second Non-Family 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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CONSENT / RELEASE
FOR OFFICIAL USE ONLY License #10317
Date Recieved
Date Contacted
DF Rep