FOS TER PARENT Q UESTIONN AIRE 1. First Name required: Please fill in all questions. If something does not apply, please enter N/A. 2. Last Name required: 3. Occupation required: 4. Street Address required: 5. City required: 6. Zip Code required: 7. Home Phone (including area code) required: 8. Cell Phone (including area code) required: 9. Work Phone (including area code) required: Page 1 of 6 March 2010
10. Email (including area code) required: 11. Spouse/Significant Other required: 12. Spouse/Significant Other Occupation required: 13. Names/Ages of Children required: 14. Type of dog desired required: 15. Does EVERYONE in your family want to foster a dog? Please indicate yes or no 16. If you live in a condo or apartment, does the association allow pets? Please indicate yes or no 17. If renting, do you have permission to keep a dog? Please indicate yes or no 18. Please tell us the landlords name and phone number required: 19. What are your primary reasons for wanting to foster a dog? required: Page 2 of 6 March 2010
20. If you have children, please describe their previous experience with dogs Required: 21. Has any member of your family ever experienced animal-related allergies? Please list: 22. Does your home have a pool? Please indicate yes or no 23. How do you introduce the dog to the pool? Required if you have a pool 24. Do you presently have a dog? Please indicate yes or no 25. Have you previously had a dog? Please indicate yes or no 26. If you presently have dogs please list their name, breed, age & sex (AND if they are neutered/spayed) Required: 27. If you have previously had dogs please list name, breed AND indicate what happened to the dog Required: 28. If you have other pets besides dogs, please list their species & ages Required: Page 3 of 6 March 2010
29. Is there anyone home during the day? Who? Required: 30. When will the dog be inside? Required: 31. When will the dog be outside? Required: 32. How many hours per day will he dog be left alone and where will it be when left alone? Required: 33. What rooms are off limits to the dog? Required: 34. What outside areas are available to the dog? Required: 35. Who would be responsible for the care of the dog? Required: 36. Where would the dog sleep? Required: 37. Where will the dog be left when he/she is alone or when you are away from your home? Required: 38. Is your yard fenced? Please indicate yes or no Page 4 of 6 March 2010
39. Type of fencing? Required: 40. Height of fence at its highest and lowest Required: 41. Please tell us what kind of locks you have on the gates? Required: 42. Have you recently inspected your fence and is it secure, without holes, gaps, or low points? If NO, and your application is accepted, do you agree to thoroughly inspect your fence and make any necessary repairs before the home visit? Required: 43. Who has access to your yard such as gardener, pool service, housekeeper, utility, neighbors, etc.? Please list all that apply: 44. Do you have a doggie door? Please indicate yes or no 45. Preferred level of exercise with dog? Required: 46. If you currently have dogs what kind of food do you feed them? Please list brand and type (dry or canned)? Required: 47. How would you rate your level of dog owning experience? Required: 48. How would you discipline your dog if he or she misbehaved? Required: Page 5 of 6 March 2010
49. Do you understand that in fostering a rescue dog you may be dealing with hair on the furniture, possible stains on your rugs, a warm body on your bed, and an animal that might be destructive at times? Please indicate yes or no 50. Under what circumstances, if any, could you imagine would cause the return of your foster dog? Required: 51. Name of veterinarian and/or other reference Required: 52. How did you hear about our foster program? Required: 53. Is there anything else you would like to tell us about yourself or your home environment? Optional: If a question does not apply, please put N/A in the box. Thank you for completing our Foster Parent Questionnaire and your interest in a dog! You too can help save a dog's life! Page 6 of 6 March 2010