FOSTER HOME APPLICATION & AGREEMENT

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

Phone Number - Work

Area CodePhone Number

Do you live in a:*

Do you:*

OwnRentLive with ParentsOther

If Renting: Please indicate landlord contact information

Household Setting

RuralCity

Describe the Activity Level in your Home

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

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

YesNo

Please list any pets you have living or deceased within the last five years (Please include Name, Breed, Age, Altered, Sex, UTD Vaccines, Heartworm, Living/Deceased)

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

YesNo

Veterinarian Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Do you have a preference in the sex of foster?

MaleFemaleNo Preference

Are you willing to foster a dog of any age?

YesNo

If not, what age would you consider?

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

YesNo

If No please explain

Are you willing and able to medicate your foster, even if it is 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

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

YesNo

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?*

What are you plans to exercise your foster? Please list any parks near by or trails, how many walks a day, approximate length, activities such as agility*

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 Russell Rescue CA dog 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 Russell Rescue CA 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 Russell Rescue CA from any liabilities or damages that may be incurred because of fostering such dog(s).I agree to have Russell Rescue CA 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 Russell Rescue CA and try to give a 2 week period to try and find another suitable foster for the dog(s).

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Co-Applicant name (if applicable)

Your name*

RUSSELL RESCUE CA

FOSTER HOME APPLICATION & AGREEMENT

www.russellrescueca.com