Adoption Application Form

How did you hear about FATHEAD Fosters?

Are you applying for a specific dog/puppy? If so whats his given name?

What kind of personality would be a good fit for your family? Are there any traits that wouldn't work well for you?

Full Name

First NameLast Name

Age

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

Do you live in a:

Do you:

If Renting: Please indicate landlord contact information

Household Setting

Describe your Homes Activity Level

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

Does Anyone in your Household have Allergies to Animals?

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

Please List all Pets. Please include Name: 1)Breed: 2) Age: 3)Spay or Neutered: 4)Sex: 5)UTD Vaccines: 6)Flea,Tick,Heartworm Prevention: 6)Living/Deceased:

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

Do you have a fenced yard?

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

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

What are your plans to exercise your new dog? Please list any parks nearby or trails, how many walks a day, approximate length, and activities such as agility.

Have you ever had to rehome a pet? If so, please tell us about it and when that was.

A dog is a long-term commitment (typically 10–17years). Are you prepared for that responsibility and commitment?

If you Need to rehome, do you agree to contact Fat Head Fosters first?

Vet Reference:

Vet Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Reference #1: Full Name(NonRelative)

First NameLast Name

Relation to applicant(s):

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Reference #2: Full Name (NonRelative)

First NameLast Name

Relation to applicant(s):

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Reference #3: Full Name (NonRelative)

First NameLast Name

Relation to applicant(s):

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

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 FATHEAD 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 FATHEAD DOG FOSTERS 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 FATHEAD FOSTERS from any liabilities or damages that may be incurred because of fostering such dog(s).

I agree to have FATHEAD FOSTERS complete reference call checks and conduct a home visit inspection to be able to approve my foster application if Applicable.

I agree that if I'm unable to keep the dog(s) anymore that I will return the dog(s) to FATHEAD FOSTERS and try to give FATHEAD FOSTERS a 2 week period to try and find another suitable situation for the dog(s).

Date

MonthDayYear

Your name

E-mail