ssass adopt/Foster Application for Dogs

Full Name of Every Adult in Household

Rows	First Name	Middle Name	Last Name
Adult 1
Adult 2
Adult 3
Adult 4

Date of Birth of Every Adult in Household

Rows	Date of Birth
Adult 1
Adult 2
Adult 3
Adult 4

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number - Home

Area CodePhone Number

Phone Number - Cellular

Area CodePhone Number

Phone Number - Work

Area CodePhone Number

Employer Name

Employer Address Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Employer Phone Number

Area CodePhone Number

Do you live in a:

Are you interested in a specific dog? If yes, who?

Are you hoping to:

Do you:

If Renting: Please indicate landlord contact information

Describe the Activity Level in your Home

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

Are all members of your Family agreeable to a new animal?

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

Would you be willing to have an SSASS Team Member call your veterinarian for a reference check? (Please authorize vet to speak with us)

Veterinarian Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Veterinarian Phone Number

Area CodePhone Number

Do you have a preference in the sex of the animal?

Do you have a preference of dog age?

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

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

Are you willing to take your dog to vet appointments at a convenient time for you?

Are you willing and able to medicate your dog, even if it is just a monthly heartworm preventative?

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

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

If Yes please explain

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

Do you have a fenced yard?

If fenced, please give details on height, material, # of gates, are gates locked or lockable? If not, please explain your plans to walk and exercise your new pet.

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

Would there ever be a reason you would surrender your pet? If so, what would that be?

Do you understand it takes approximately 3 days for an animal to start to relax, 3 weeks for their personalities to show, and 3 months for them to be fully comfortable and confident in their new home?

Do you have a preference in the sex of the animal?

If fostering, are you willing to foster a dog of any age?

If not, what age would you consider?

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

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 at a convenient time for you?

If No please explain

Are you willing and able to medicate your foster, even if it is just a monthly heartworm preventative?

Do you have a preference in the sex of the animal?

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 Stray Safe Association 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 SSASS and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the foster dog. This includes but is not limited to damages, injury, or illness that this dog may unknowingly carry.

I accept full responsibility for the dog(s) actions at all times, and release SSASS from any liabilities or damages that may be incurred because of fostering such dog(s). I agree to keep dog leashed and maintain control at all times to prevent accidents.

I agree to have SSASS 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 SSASS and try to give SSASS a 2 week period to try and find another suitable foster for the dog(s).

Your name

Co-Applicant name (if applicable)

Date

Time HourMinutesAM/PM Option

Photo of Home

Photo of Yard

SSASS Adoption/Foster Application