Placement and Fostering Application

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 NameLast Name
Occupation*
Current Resident Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long at this residence?
Daytime Phone
Please enter a valid phone number.Format: (000) 000-0000.
Evening Phone
Please enter a valid phone number.Format: (000) 000-0000.
Best time to call?
Email*
myname@example.com
Are you seeking to adopt or foster a dog?*

FosterPermanent Placement/OwnFoster 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?

SmallMediumLargeN/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?

YesNoFor a dog's entire lifeN/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?

YesNo
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?*

SingleTownhomeApartmentFarmOther
Please describe your household:*

ActiveNoisyQuietAverage
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?*

YesNo
Is everyone in agreement with the decision to get a dog?*

YesNo
Do you have time to provide adequate love and attention?*

YesNo
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?

YesNo
Veterinarian's Name

First NameLast Name
Clinic Name
Clinic Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Clinic Phone
Please enter a valid phone number.Format: (000) 000-0000.
Please tell us about the ideal dog you wish to own or foster.
What traits are you looking for in a dog?*
Age Preference*

PuppyYoung adultAdultSeniorAny
Desired Size*

SmallMediumLargeGiantAny size
Desired Breed*
Desired Sex*

Spayed FemaleNeutered MaleNo preference
Willing to Foster or Own (Choose all that apply)*

Outgoing/hyper dogDog that needs regular medicationDog that needs groomingShy dogDog that needs basic trainingDog that needs help learning house training skillsNone 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?*

YesNo
Do you plan to house the dog?*

IndoorOutdoorBoth
Do you have a fenced yard?*

YesNo
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?*

YesNo
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?*

YesNo
Would you be interested in fostering?*

YesNoWould 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?*

YesNo
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 NameLast Name
(#1) Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(#1) Phone
Please enter a valid phone number.Format: (000) 000-0000.
(#1) Relationship (relative, neighbor, friend, etc.)
(#2) Name

First NameLast Name
(#2) Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(#2) Phone
Please enter a valid phone number.Format: (000) 000-0000.
(#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
Should be Empty:

Placement and Fostering Application Form

Contact Information

Family & Housing

Other Pets

Veterinarian Information

Please tell us about the ideal dog you wish to own or foster.

Personal References