Host Request Form

Host Request Form

Please complete this form to request coverage for the dog in your care. Puppy Program staff will post requests for coverage and assign dogs to volunteers.
Your Name*

First NameLast Name
Email*
example@example.com
Assignment Start Date*

MonthDayYear
Date
Assignment End Date*

MonthDayYear
Date
Comments regarding the dates requested?
Dog's Name*
Dog's Age*
Dog's Breed*
Is the dog spayed or neutered?*

YesNo
Is this dog in the breeding program?*

YesNoI'm not sure
Please list any appointments scheduled for this dog during the requested dates.
For example: vaccinations, breeding appointments, x-rays, etc.

MEALS
What type of food is the dog eating?*

Purina Pro Plan Large Breed PUPPYPurina Pro Plan Large Breed ADULTPurina Pro Plan Sensitive Skin & StomachPurina Pro Plan Sport 30/20Other
How much does this dog eat PER MEAL?*
How many meals does the dog eat PER DAY?*

OneTwoThreeOther
At what times is the dog used to eating?*

MEDICAL
Please describe any medical conditions you are currently addressing with this dog.
Is this dog currently recovering from a surgery or medical concern?*

YesNo
Please describe what they are recovering from and the restrictions, if applicable.
Please list any medications this dog is taking along with dosages.
If you are fostering an intact female, are they in heat?

YesNoUnknown

POTTY HABITS
Please describe the dog's daily potty routine as well as how the dog indicates it has to go. *
Is there anything else that fosters should know about this dog's potty habits?
Example: this dog will urinate if upset in her crate.

EXERCISE ROUTINE
Are there things we should know regarding this dog and exercise or play?

Limit waterLimit toy playMay destroy toys (watch carefully)May ingest toysPlays "keepaway"Does not share toys with other dogs
Please indicate what equipment this dog uses for walks.*

HOUSE MANNERS
Please describe this dog's house manners, including any less-than-desirable behaviors. *

PREFERENCES
This dog lives with:*

Other dogsCatsChildren (under 10)Children (10 and older)AdultsSmall animalsLarge animals
How does this dog behave around other dogs? *
How does this dog behave around cats? *
How does this dog behave around children? *
Should be Empty: