Res-Q-Me Dog Interest/Foster Application

Res-Q-Me Dog Interest/Foster Application
The first step in the process of Adopting a Res-Q-Me dog or becoming a Foster is to complete this application. The application provides important information. With the information on your application, along with a home check we will find a pet well-suited to your lifestyle. Please provide detailed information for all questions.
To qualify for Adoption or be a Foster, you must:
•Be at least 21 years old and have a valid driver's license or state Identification Card stating your current address
•Have the knowledge and consent of a landlord, if relevant
•Be able and willing to spend the time training, working with and giving the pet affection. Please note: We reserve the right to refuse Adoption or Foster to anyone. Please be advised that we will not adopt or foster to persons who mislead or fail to provide accurate information on this application.
Today's Date*

MonthDayYear
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number Home*

Area CodePhone Number
Phone Number Cell

Area CodePhone Number
E-mail*
Driver's License Number*
Do You Rent or Own Home?*

Own HouseOwn CondoRent HouseRent CondoRent ApartmentLive With Family
Are you planning on moving anytime soon?*

YesNo
If renting, may we contact your landlord?*

YesNoN/A
Landlord Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Do you have children in the home?*

YesNo
Please list the ages of all children in the home. *
Do you have a pool?*

YesNo
Is your pool above ground or in-ground?*
Is your pool enclosed with a fence or other structure?*

YesNo
Please list all other pets in your household, their breeds and ages. *
Are you current dogs shots up to date?*

YesNo
Are your current pets spayed/neutered?*

YesNo
If your pets are not fixed please explain why.*
Please provide Your Current Veterinarian Information *
May We Contact Your Vet *

YesNo
Have you ever taken a pet to a shelter or given a pet away?*

YesNo
Explain why you have taken pet to the pound.*
Explain where your new dog will sleep i.e. in a crate, separate room etc.*
Explain where your new dog will be kept if it is left alone.*
Explain what behavior issues would be a problem for you. *
Name or Breed of Dog you are interested in Adopting or Fostering *
Desired Level Of Activity with New Dog

Short WalksIntense Tricks/TrainignHikingBackyardSwimmingCouch Potato
Dog Preference Information

SmallMediumLargePuppyAdultSeniorShort HairedLong HairedHypoallergenicMaleFemale
Do You Agree to Try Training if Your New Dogs Needs It?

YesNoMaybe
Is there any additional information you would like to provide?*
I agree to seek veterinary care, follow up and/or check-ups when necessary and follow the standard animal care protocol for my new pet. *

I Agree
I also understand and agree that I must undergo a home-check to be done by a Res-Q-Me designee prior to any pet I am looking to adopt or foster.*

I Agree
By signing (typing your legal name) in the space below, you are certifying that all information is correct and true and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print this for your records and retain as verification of your application.*

First NameLast Name
BowWow Verification*
Should be Empty: