Newnan-Coweta Humane Society and Shelter Rescue

First name:
Last name:
Address:
City:
State:
Zip:
Daytime Phone:
Evening Phone:
Cell Phone:
Email address:
Fax Number:
How did you hear about us?:
Do you have a home computer?:	Yes No
Do you have a printer?:	Yes No
Best time to contact:
Emergency Contact Name and Number:
Please list any other adults living in the household:
Please list names and ages of any children who either live with you or visit you on a regular basis (include any grandchildren or other relatives) :
Please list names,ages, spay/neuter status, species (dog, cat, etc.) and breed of ALL pets in your household :
Are there any relative's pets frequently in your home?:	Yes No
If so, please provide all info requested above, for those pets :
Do you take care of friends' pets in your home while they are on vacation?:	Yes No
If so, please provide all info requested above, for those pets :
How does your dog(s) react to other dogs (friendly, submissive, growls, etc) :
Are ALL dogs in your household current on ALL recommended and/or required vaccinations?:	Yes No
Please list dates of last vaccinations (Rabies, DHLPP, Bordatella) :
Name, address and phone of current Veterinarian (require 3-year history, so list more than one if necessary).  Please include the name the vet records are listed under if different from applicant's name :
Have you ever had a dog diagnosed and/or treated for heartworms?:	Yes No
If yes, please explain :
Do You:	Own Rent
Do you reside in:	House Townhouse Apartment Duplex Other
If you rent, do you have the landlord's permission to have a dog over 50 lbs?:	Yes No
Landlord's name, address and phone number :
Do you have a fenced yard?:	Yes No
What type of fencing do you have?:
What height?:
Do you allow your dogs to run in any unfenced areas?:	Yes No
If yes, please explain?:
Are you employed:	Full-Time Part-Time Both Other
Is anyone home during the day?:	Yes No
If so, who?:
If yes, where will the dog be during the day?:
If no, where will the dog be during the day?:
Where will the dog be kept at night?:
If no one is home during the day, how many hours will the dog be alone?:
Are you familiar with crate training?:	Yes No
Do you have a crate available for use with your foster dog?:	Yes No
What type of dog training experience do you have? :
Are you aware that a foster dog may jump, bark, chew or display other undesirable behavior while in your care?:	Yes No
Have you ever taken an obedience course with a dog?:	Yes No
Is your own dog obedience trained?:	Yes No
Are you willing to work with your foster dog in areas such as house training, basic obedience commands such as "come, sit, stay, down, off", and walking on a leash?:	Yes No
Have you had experience in introducing dogs into your household?:	Yes No
If yes, please describe how this was accomplished :
Are you familiar with the concept of who in the household is the Alpha or dominant dog?:	Yes No
If so, please describe who your example of Alpha is :
Should a disagreement or fight occur between your own dog(s) and a foster dog, how would you handle the situation? :
What actions would you take to avoid this situation in the future? :
Are you willing to supervise any children around your foster dog at ALL times?:	Yes No
Please describe the type(s) of foster dogs you are willing to have in your home i.e. puppies, female, male, senior? :
How many dogs are you willing to foster at one time? :
Is there a preferred activity level for a dog you would want to foster? :
Is there a preferred size foster dog you are willing to foster (i.e., small - under 25 lbs, medium - 25-45 lbs, large - over 45 lbs)? :
Please describe your level of experience as a dog owner and provide an honest assessment of you abilities to recognize and deal with any problem behaviors a foster dog might exhibit (i.e. barking, growling, possessiveness of toys or food, chewing, digging, lack of house training, seperation anxiety, etc.) :
Describe any medical treatment or special care you have given dogs (trim nails, clean ears, administer medication, etc) :
Have you ever been cited by Animal Control?:	Yes No
If so, what state, county, when and for what reason? :
Have you ever fostered a dog before?:	Yes No
If yes, please explain? :
If a member of an obedience club, breed club or another rescue, please list :
I/we acknowledge that all the information provided is true and correct and that I/we have answered all questions truthfully.  Submission of application does not guarantee placement of a foster dog through Newnan-Coweta Humane Society and Shelter Rescue.Request information on:

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