Senior2Senior Forever Foster Application

How did you hear about LGCR's Senior2Senior Forever Foster Program?

Examples: Friend, I'm an LGCR Volunteer, Social Media, Event

Full Name*

First NameLast Name

Age*

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number - Home

Area CodePhone Number

Phone Number - Cellular*

Area CodePhone Number

Do you live in a:

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)

Do you currently have any pets? Name, Breed, Age, Altered, Sex, Up-To-Date on Vaccines*

Please list the most recent deceased pet. Name, Breed, Age at death, Cause of Death and how many years in your loving care.

Do you have a preference in sex of foster?

MaleFemaleNo Preference

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

SmallMediumLarge

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

Are you willing to take your foster dog to vet appointments?

YesNo

If No please explain

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, # of gates, are gates locked or lockable?

How many hours in a day would the foster be left alone?

How will you foster companion receive daily exercise?

Vet Reference

Veterinarian Clinic Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

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

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 LGCR canine I fostered.

I certify that the above information is correct.

I understand that by submitting this form electronically, I agree to release and covenant to hold harmless LGCR and its members from any claims, damages, costs, or actions incurred because of the foster dog's care or actions.

I accept full responsibility for the dog(s) actions at all times and release LGCR from any liabilities or damages that may be incurred because of fostering such dog(s).

I agree to have LGCR complete reference call checks and conduct a home visit inspection to approve my foster application.

I understand and agree that fostering an LGCR canine is a lifelong commitment, and I will abide by all LGCR written and verbalized guidelines.

Date

MonthDayYear

Your name*

E-mail