AVGRR Foster Home Application

PERSONAL INFORMATION Date of Application ___________

Name of Applicant ______________________________________________________

Address _______________________________________________________________

City, State, Zip _________________________________________________________

Phone ________________________ e-mail _________________________________

Employer _______________________________City __________________________

Occupation _______________________ Typical # of Hours Worked ____________

Name of Co-Applicant (Adults over 18 yrs only) _____________________________

Relationship to Applicant: Spouse ___ Significant ____ Roommate____ Other ____

Employer: _______________________________ City _________________________

1. How did you hear about Autumn Valley Golden Retriever Rescue?

____________________________________________________________________

2. Why do you want to foster a Golden Retriever? __________________________

3. Humans in the household? Adult _________ Ages _________________

Children _________ Ages _________________

4. If there are children in the household (including visiting grandchildren), are

they experienced with pets/dog? ______________Yes ______________No

5. Who would have primary responsibility for caring for a foster dog? _________

6. Do you have any health problems, which might affect your fostering

7. Are you willing/able to adjust your schedule (if needed) while a foster dog

becomes acclimated to you home? ______ How? __________________________

8. Is there anyone home during the day? _______ Who? _____________________

If not, how long will the foster dog be left alone? __________ Where will he be

kept while alone? _______________________

9. Please describe your experience with dogs, including any formal obedience

training which you have participated.

10. Do you have any training in behavior training of modification?____________

If yes please describe? _______________________________________________

11. Do you own a large crate and are you familiar with the use of crates as it

relates to dog training? _______________________________________________

12. Describe any medical treatment you have given to dogs (i.e. shots, pills, or

other medication, etc.) _______________________________________________

13. Are you comfortable with _____bathing a dog _____ grooming a dog

_____housetraining _____clipping toenails _____giving oral or topical

medications ______shy dogs ________active dogs.

14. Have you ever had a pet/dog die at an early age, please give details ________

___________________________________________________________________

15. Are there any restrictions on how long you can foster a dog? ______________

___________________________________________________________________

16. Are you prepared to commit to fostering, knowing that a foster could possibly

stay in your household for several weeks/months? ______________________

1. Do you live in a ___house ___townhouse ___apartment ____mobile home

___other ___________________________________________________________

2. Do you ______own __________rent.

3. If you rent, what is the landlord’s policy on pets/dogs? ____________________

4. Landlords Name ________________________Phone _______________________

5. Do you have a fenced yard? _________What type ______________________

Height of fence? ____________________________________________________

6. If you do not have adequate fencing (i.e. totally enclosed & secure) how will

you provide exercise for the dog? (potty exercise and physical exercise)?

___________________________________________________________________

7. Who will be the primary person responsible for exercising the foster dog?

___________________________________________________________________

8. Where will the foster dog spend its daytime? ___________________________

9. Where will the foster dog sleep at night? _______________________________

10. What dog food do you currently feed your dogs? _______________________

11. How many times per day do you feed your dogs? _______________________

12. What types of "dog supplies" do you currently have on hand? ____________

__________________________________________________________________

13. Do you have pets in your home now? _____Yes ______No

14. If yes, please list all pets, Sex, breed, ages, spayed/neutered

Dogs ____________________________________________________________

Cats ____________________________________________________________

Other ___________________________________________________________

15. Do your pets live ____inside ___mostly inside ____ mostly outside ___outside

16. Are your dogs house trained? _____Yes _____No.

17. List ANY behavior problems your dogs have. ___________________________

___________________________________________________________________

___________________________________________________________________

18. Have your dogs ever bitten a human? __________Yes ____________No

19. If yes, please give full details _________________________________________

___________________________________________________________________

___________________________________________________________________

20. Have your dogs ever shown aggression towards other animals?

___________Yes _____________No

21. If yes, please give full details _________________________________________

___________________________________________________________________

___________________________________________________________________

22. Are all of your dogs/pets current on all vaccinations? _____Yes _____No

23. What types of Goldens are you willing to foster? ____Males ____Females

____Adults ____Puppies ____Dogs taken in from private owners

____Dogs taken in from shelters ____Abused/Neglected dogs

____Injured/sick dogs

24. Any comments or concerns that you have concerning fostering?

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Please list 2 references: Name/relationship/complete phone number:

1. ____________________________________________________________________

2. ____________________________________________________________________

Veterinarian that you use the most: Name and phone number

______________________________________________________________________

How long have you used this veterinarian? ________________________________

How many minutes drive from you house is this veterinarian? _______________

I acknowledge that the information contained in this form is true and correct to the best of my knowledge. I understand that any misrepresentation of fact, may result in the removal of the foster dog from my home.

Signature of Applicant __________________________________Date ____________

Give this application to any officer of the Autumn Valley Golden Retriever Rescue