04-ON.WEB-HOMESFORPAWSDOGRESCUE.COM_04_FINAL - Palliative Care Application Form_2020 (#20) (#40)
Name of the person fostering
Email
Phone Number (Include area code)
Phone Type
- Select -
Home
Work
Other
Name of Foster Dog (N/A if no preference or unknown)
Breed of Foster Dog (If known)
Foster Dog is of which Gender?
Female
Male
Age of the foster dog?
What type of home do you live in?
Do you rent or own?
Rent
Own
If renting, are pets allowed?
Yes
No
Names and Ages of all Permanent Residents of your home (adults/children)
Your Address (please include postal code)
Who will have primary responsibility for the dog?
Current pets in your home (species, breed, name, age, sex, spayed/neutered?)
Are all existing pets in your home use to other dogs?
Yes
No
Have you fostered a dog previously?
Yes
No
Are you aware that small objects are a very real choking hazard for dogs of any age?
Yes
No
May be
Are you aware of foods that are dangerous for dogs to ingest? (xylitol - a sweetener in candies, toothpaste, chewing gum, chocolate, grapes, onions, etc.)
Yes
No
If you are you willing to work on any behaviour issues, describe how?
Have you crate trained a dog before?
Yes
No
Have you house trained a dog before?
Yes
No
What form of exercise can you provide the dog? How often (hours/day)?
What is your philosophy or method of training a dog? If necessary, how will you discipline the foster dog?
Where will the foster dog sleep?
Do you have a fenced yard?
Yes
No
Do you work outside the home?
Yes
No
How many hours/day will the dog be alone?
Where will your dog stay when you are out?
If your foster dog is not house trained and needs some training, are you willing to help the dog with this?
How would you prevent your foster from destructive or mischievous behaviour?
Do you access to a vehicle?
Are you comfortable giving medication?
Are you comfortable giving SQ fluids if needed?
Do you have any relevant experience that may be a benefit for a palliative foster?
Do you understand that the length of the palliative foster period is unknown and in some cases may be years?
Reference # 1 (Name, Phone, Relationship) i.e. friend, neighbor, pet sitter, etc. No family members please.
Do you have any additional comments, questions or concerns?
Anything else you would like us to know to help match you up to a foster dog?
I/We hereby certify that all information is true.
Yes
Applicant's Signature (First and Last name)
Signature date
Submit Form