Placement and Fostering Application Form
The purpose of this form is to help us get you matched with the very best dog for you and your family. Please do not feel you are being judged or excluded from receiving an animal. We think all dogs need great homes and this helps us to place the right dog with you and to have your contact information all in one place.
Contact Information
Name
*
First Name
Last Name
Occupation
*
Current Resident Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long at this residence?
Daytime Phone
Please enter a valid phone number.
Evening Phone
Please enter a valid phone number.
Best time to call?
Email
*
myname@example.com
Are you seeking to adopt or foster a dog?
*
Foster
Permanent Placement/Own
Foster with first option for permanent placement
What specific dog or breed are you interested in?
If you are interested in being a Foster/Trainer would you prefer small, medium or large dogs?
Small
Medium
Large
N/A ONLY want permanent placement
Is there a hair coat/breed/type you prefer NOT to work with?
Are you able to commit 2 to 8 weeks to a dog as a Foster/Trainer?
Yes
No
For a dog's entire life
N/A only want to have a permanent placement/own
If the specific dog you are interested in is no longer available, would you be interested in a similar dog should one come available?
Yes
No
Family & Housing
How many adults live in your house?
*
How many children in your home (specify ages)?
*
What type of home do you live in?
*
Single
Townhome
Apartment
Farm
Other
Please describe your household:
*
Active
Noisy
Quiet
Average
Other Description:
If you rent, please give the rules governing pets and the landlord's name and number:
(by providing this information you are allowing SOLOMONS People and Pets, LLC to contact your landlord please inform them of this call so they will speak with us)
Does anyone in the family have a known allergy to dogs?
*
Yes
No
Is everyone in agreement with the decision to get a dog?
*
Yes
No
Do you have time to provide adequate love and attention?
*
Yes
No
Activities you like to do and what ones you would like to do with a dog?
Other Pets
What other pets do you have (specify type and number)?
Are these pets up to date on vaccines?
*
Are these pets spayed/neutered?
*
Have you ever surrendered a pet? If so, why?
*
Have you ever had a pet euthanized? If so, why?
*
Have you ever lost a pet to an accident?
*
How do you discipline your pets and why?
*
Veterinarian Information
Do you have a regular veterinarian?
Yes
No
Veterinarian's Name
First Name
Last Name
Clinic Name
Clinic Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Clinic Phone
Please enter a valid phone number.
Please tell us about the ideal dog you wish to own or foster.
What traits are you looking for in a dog?
*
Age Preference
*
Puppy
Young adult
Adult
Senior
Any
Desired Size
*
Small
Medium
Large
Giant
Any size
Desired Breed
*
Desired Sex
*
Spayed Female
Neutered Male
No preference
Willing to Foster or Own (Choose all that apply)
*
Outgoing/hyper dog
Dog that needs regular medication
Dog that needs grooming
Shy dog
Dog that needs basic training
Dog that needs help learning house training skills
None of these
Where will the dog spend the day? (Describe)
*
Where will the dog spend the night? (Describe)
*
Number of hours (average) dog will spend alone?
*
Who will have financial responsibility for this dog?
*
Do you agree to provide regular health care by a Licensed Veterinarian?
*
Yes
No
Do you plan to house the dog?
*
Indoor
Outdoor
Both
Do you have a fenced yard?
*
Yes
No
If you do not have a yard, when the dog goes out, how do you plan to supervise it?
Do you agree to contact SOLOMONS People and Pets, LLC if you can no longer keep this dog?
*
Yes
No
Are you willing to let a representative or the designee of SOLOMONS People and Pets, LLC do a home visit? All visits are by appointment?
*
Yes
No
Would you be interested in fostering?
*
Yes
No
Would like to know more
There is a chance some of the dogs from this program have been involved in a research study with Purdue University Center for Animal Welfare Science (CAWS). Would you answer follow up questions from Purdue about any dog you may take possession of?
*
Yes
No
How did you hear about SOLOMONS People and Pets, LLC?
*
Personal References
Please list someone who is familiar with both you and your pets.
(#1) Name
First Name
Last Name
(#1) Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
(#1) Phone
Please enter a valid phone number.
(#1) Relationship (relative, neighbor, friend, etc.)
(#2) Name
First Name
Last Name
(#2) Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
(#2) Phone
Please enter a valid phone number.
(#2) Relationship (relative, neighbor, friend, etc.)
By submitting this application, I agree to the terms of fostering and/or permanent placement/ownership. All of the information I have given is true and complete. Any dog placed within my care as a permanent placement or foster will reside at my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, and affection. For permanent placements, I will provide an annual physical examination, vaccinations, and monthly heart worm preventative under the supervision of a licensed Veterinarian. If I can no longer foster or keep a permanently placed pet, I agree to contact SOLOMONS People and Pets, LLC for first right of refusal and no buy back or transportation fees. The refusal must be received in writing prior to me making any other arrangements for my animal. If this pet has been part of the Purdue Center for Animal Welfare Science Research project, I agree to talk to them about any dog I receive from SOLOMONS People and Pets, LLC so they may follow up on their research participants.
Signature
*
Parent/Guardian Signature if under 18
Submit
Should be Empty: