Your information
Name:
Name of Spouse:
Address:
City:
State:
Zip:
Home phone:
Work phone:
Cell phone:
Email address:
Which of the following services are you able to provide:
Transportation
Fostering
Rescuing from shelter
Administrative services
Which geographic areas can you cover? (please list counties)
If you are interested in fostering, please answer the following:
Do you currently own a dog?
Yes No
If so, how many dogs and what are their names, ages and breeds?
Are your dogs current with all their shots, including bordetella?
Yes No
What type of flea and tick preventative do you provide for your dog (and cat(s) if you have them)?
If you do NOT own a dog, tell us about your dog experience.
Do you have any cats?
Yes No
Do you have a fenced in yard?
Yes No
Do you routinely work away from home?
Yes No
Please tell us how many hours per day you are away from home
Please tell us more about your daily routine or work schedule
Do you have a space inside your home where you can safely confine a dog when you are gone?
Yes No
Are you willing to crate train a dog?
Yes No
Have you spoken with your spouse or partner about volunteering - and is he/she amenable to the idea?
Yes No
Please provide the contact information for your vet, as we will contact him or her:
Name
Address
Telephone number
Do you have children at home?
Yes No
If yes, what are their ages?
Do you have children/grandchildren that are visiting you?
Yes No
If yes, what are their ages?
Please provide two personal references whom we will contact. We will need their names, phone numbers and email addresses.