Foster Home Application form

Full Name*

First NameLast Name

Age

E-mail*

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number - Cellular

Area CodePhone Number

Phone Number - Work

Area CodePhone Number

Do you live in a:

Do you:

OwnRentLive with OthersOther

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

Please List any Pets you have (Please include Name, Breed, Age, Altered, Sex, Current on vaccines (including Rabies, Parvo/Distemper and Bordetella)*

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

YesNo

Are you willing to foster for a time frame of 2 weeks?

YesNo

Are you willing to take your foster dog to vet appointments at a convenient time for you? This is not a requirement

YesNo

Are you willing and able to medicate your foster, 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

Do you have a fenced yard?

YesNoPartial

If fenced, please give details on height, material.

How many hours in a day would the foster be left alone? Are you willing to crate your foster when you are not home? Crate will be provided!

What are you plans to exercise your foster?

Vet Reference: Full Name*

First NameLast Name

Vet Address

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number

Area CodePhone Number

E-mail

Date

MonthDayYear

Your name*

E-mail

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I certify that the above information is correct, and I understand that the information will be verified.

I understand that all needed supplies (crate, food, toys, medication, etc.) will be provided by Bully Smiles, and that I will not need to provide anything for the potential foster, other than a safe home, cleaning, and socialization.

I have inquired about the specific animal I am interested in fostering, I am aware of their current health conditions, vaccine status, and we have discussed my personal pet(s) safety against contagious diseases and parasites.

I understand that by submitting this form electronically, I agree to release and covenant to hold harmless Bully Smiles Inc. 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 BSI from any liabilities or damages that may be incurred because of my neglegence.

I agree to have BSI 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 BSI and try to give BSI a 1 week period to try and find another suitable foster for the dog(s).