Canine Respite Care Provider Application

Canine Respite Care Provider Application
Thank you so much for applying to be a respite care provider for a dog who needs your help on a temporary basis. We appreciate your interest. This application helps us get to know you so that we can place the right dog with you.

If you have any questions at all, please email to adopt@friendsofnoah-wi.org or call us at 608-774-3402 and you will be put in touch with the Canine Foster Manager.

Again, thank you for your interest. We look forward to getting to know you better.
Contact Information
Applicant Name

First NameMiddle NameLast NameSuffix
Applicant Nickname (if applicable)
Date of Birth

MonthDayYear
Date
Email
example@example.com
Best Phone #

Area CodePhone Number
Co-Applicant Name

First NameMiddle NameLast NameSuffix
Nickname (if applicable)
Date of Birth

MonthDayYear
Date
Email
example@example.com
Best Phone #

Area CodePhone Number
Residency Information
Address*

Street Address 1

CityState

Postal Code
What county do you live in? If your county is NOT listed, select OTHER and type in the name of the county below. *
If OTHER selected, please type in county:
COUNTY OF RESIDENCE
Please indicate what best describes your dwelling:

ApartmentCondoDuplexTownhomeHouse
Please indicate which best describes your dwelling

	Yes	No
Do you own your own home?
Do you rent your home?
If renting, does your lease agreement/landlord permit dogs?
If yes, is that information available in writing upon request?
Would you consent to a home visit by Friends of Noah — WI personnel upon request?
Do you have a fenced in yard?

If you answered yes to having a fenced in yard, describe the style of fencing:

Chain LinkElectricFarm Wire FencingInvisibleWooden (no liner)Wooden (with liner)
If yes, please describe the style of fencing:
People
Are there other adults living in the household? If so, please list their names and DOB.
First name, MI, Last Name, Date of Birth
Are there children living in the household or regular visitors to the home? If so, please list their names and DOB.
First Name, MI, Last Name, Date of Birth

	Yes	No
Are the children allergic to or afraid of dogs?
Are the children experienced around dogs?

Your Canine Experience
How many years have you been involved with dogs?
In what capacity?

Animal OwnershipBreedingTrainingShowingOther
Have you or do you currently foster dogs for another rescue group?

YesNo
If yes, please give the name of the group, dates you volunteered and a summary of your overall experience with them.
Environment
How many hours a day will the foster dog(s) be unattended?
How will the foster animal be housed during that time?

Crated alone, separate from other dogsCrated with other dogsIndoors loose, run of the homeIndoors loose, secure in a roomOutdoors in fenced yardOutdoors in other environment
Describe if outdoors in other environment:
Do you own a crate for foster dogs use?

YesNo
Do you own a crate for foster dogs use?
Animals in the Household

List all other pets (dogs or cats) living in the home. Please click + to add additional pets.

	Yes	No
Do your current dogs get along with new dogs coming into their home?
At least initially your new foster dog would need to be in a separate, safe area as he/she gets acclimated to your home. Do you have an area like this in your home?

References
Your Veterinarian
Please list TWO personal references who meet the following criteria:
- Not family members or directly related to you
- Are knowledgeable about and familiar with your care of animals
- Are not the veterinarian listed above
First reference contact
Second reference contact
Preferences
Preferred gender of foster animal:
Size of animal(s) that you prefer to foster:

Are you willing to foster animals that may have the following unique circumstances?

	Yes	No
An animal being treated for kennel cough?
A heart worm positive dog?
A dog that is injured?
A dog with a litter of puppies?
Puppies being bottle fed?
A dog with behavior problems?
A dog that is not housebroken?

Is there any additional information about you, your family, your experience, your animals, or potential foster animals that is useful for us to know that may assist us with better animal placement?
Electronic Signature
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 FRIENDS OF NOAH 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 FRIENDS OF NOAH 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 FRIENDS OF NOAH from any liabilities or damages that may be incurred because of fostering such dog(s).

I agree to have FRIENDS OF NOAH 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 FRIENDS OF NOAH and try to give FRIENDS OF NOAH a 2 week period to try and find another suitable foster for the dog(s).
I agree that by submitting this application, I am electronically signing the application.

I,
Given Name(s)*
Last Name*
, solemly declare that the information I have provided is true and the document that I am submitting in support of my application are genuine and have not been altered in any way.
Cell Phone

Area CodePhone Number
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Canine Respite Care Provider Application

Contact Information

Residency Information

People

Your Canine Experience

Environment

References

Preferences

Electronic Signature