Brizzee Animal Rescue Application

Please remember to hit "SUBMIT" at the end or your information will not be saved and sent to us. Contact us at BrizzeeAnimalRescue@yahoo.com with any questions regarding this form. Thank you!

Full Name*

First NameLast Name

E-mail*

Age*

Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Phone Number - Home*

Area CodePhone Number

Phone Number - Cellular*

Area CodePhone Number

Employer*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Work Phone Number *

Area CodePhone Number

Do you live in a:*

Do you:*

OwnRentLive with ParentsOther

If Renting: Please indicate landlord contact information

Household Setting

RuralSuburbanUrban

Describe your Homes Activity Level*

Busy/NoisyModerate Comings/GoingsQuiet with Occasional Guests

Please List all People Living in the Household (Include Name, Relationship, Gender and Age)*

Does Anyone in your Household have Allergies to Animals?*

YesNo

Are all members of your Family agreeable to Fostering/Adopting a Dog?*

YesNo

Please List any Pets you have Living or Deceased (Please include Name, Breed, Age, Altered, Sexe, UTD Vaccines, Heartworm, Living/Deceased)*

Would you be willing to have Brizzee Animal Rescue call your veterinarian for a reference check? (Please authorize vet to speak with us)*

YesNo

Veterinarian Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

I understand that I need to contact my veterinarian and let them know that they have my permission to give Brizzee Animal Rescue any needed information relative to the adoption process. And that by not doing so will slow down the process.

Do you have a preference in sex of foster/adoption?*

MaleFemaleNo Preference

Are you willing to foster/adopt a dog of any age?*

YesNo

If not, what age would you consider?

What size dog are you willing to foster/adopt? (Check all that apply)*

SmallMediumLarge

Please describe the type of dog you are willing to foster/adopt (Please include breed, coat length, personality traits, energy level, hypoallergenic) We always want to make sure we have the best fit for our foster/forever homes*

Are you willing to take your foster/adopted member to vet appointments at a convenient time for you?*

YesNo

If No please explain

Are you willing and able to medicate your foster/adopted member, even if it just a monthly heartworm preventative?*

YesNo

We cannot guarantee a dog to be housebroken, are you equipped to train with love and patience?*

YesNo

Have you had any experience with with an emotionally or physically neglected or abused dog?*

YesNo

If Yes please explain

Are you willing to use a crate for a dog if recommended?*

YesNo

Do you have a fenced yard?*

YesNoPartial

If fenced, please give details on height, material, # of gates, are gates locked or lockable?

Will your foster/adopted member be left in the yard unattended?*

YesNo

How many hours in a day would the foster/adopted member be left alone?*

What are you plans to exercise your foster/adopted member? Please list any parks near by or trails, how many walks a day, approximate length, activities such as agility*

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully. I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any Brizzee Animal Rescue animal fostered by me. I certify that the above information is correct, and I understand that the information will be verified. I understand that by submitting this form electronically, I agree to release and covenant to hold harmless Brizzee Animal Rescue and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the foster dog. I accept full responsibility for the dog(s) actions at all times, and release Brizzee Animal Rescue from any liabilities or damages that may be incurred because of fostering such dog(s). I agree to have Brizzee Animal Rescue complete reference call checks and conduct a home visit inspection to be able to approve my foster application. I agree that if I'm unable to foster the dog(s) anymore that I will return the dog(s) to Brizzee Animal Rescue and try to give Brizzee Animal Rescue a 2 week period to try and find another suitable foster for the dog(s).

Date*

MonthDayYear

Your name*