Application to Provide Temporary Housing of a Rescue Dog

First Name: ______Last Name: ______

Street Address: ______

City: ______State: ______Zip: ______

Home Phone: ______Cell Phone: ______

Best time to reach you: ______

Email Address: ______

Date of Birth: ______

Please answer the following question and return this form to the address below.

1. What type of home do you live in? Please circle one

Apartment Condo Townhouse Single family home

2. If you rent, does your landlord permit dogs? Yes No

3. If yes, what is the weight limit? ______

4. Landlord’s name and phone number: ______

______

5. Do you have a fenced yard? Yes No

6. If yes, briefly describe it: ______

7. If no, do you agree to keep the dog on a leash when outdoors? Yes No

8. Do you currently have any dogs or cats of your own? Yes No

9. If yes, please describe your pets: (Age/breed/male/female) ______

______

10. Are your pets spayed/neutered? ______

11. If you don’t currently have pets, have you ever owned a dog in the past? Yes No

12. Tell us about your previous pets and why you no longer have them: ______

______

13. Why do you want to help a rescue dog? ______

______

14. Make up of household: Adults ______Children (and their ages) ______

15. Is anyone in your family allergic to animals? ______

16. Who will be primarily responsible for the care of the dog? ______

17. How many hours per day will the dog be left alone? ______

18. Where will the dog be kept during the day? ______

19. Where will the dog be kept at night? ______

20. Are you willing to house train a dog if necessary? Yes No

21. Have you ever crate-trained a dog before? Yes No

22. Do you have a crate available for your foster dog? Yes No

23. What size is your crate? ______

24. Do you have a veterinarian that you use? Yes No

25. If yes, please provide the vet’s name and phone: ______

______

26. What pet names and last name are your records under? ______

______

27. If necessary, are you willing to take the K9 Kindness dog to a vet approved by K9 Kindness Rescue? Yes No

28. Are you willing to have someone from K9 Kindness visit your home prior to placing a dog with you?

Yes No

29. Are you willing to house a special needs or senior dog? Yes No

30. Are you willing to house a dog recovering from surgery and/or on medication?

Yes No

31. Will you be able to provide your K9 Kindness dog with quality brand dog food? (By this we mean food other than generic, Old Roy, Kibbles ‘n Bits, etc.) Yes No

32. Have you ever given up on a dog? Yes No

33. If yes, explain the situation: ______

______

34. Have you ever provided temporary care for a rescue animal before? If yes, explain: ______

______

35. What method of correction will you use to train and correct the dog? ______

______

36. References: (Please do not use family members.)

Name: ______Phone: ______

All of the information I have provided on this application is true and complete. I understand that falsifying anything on this application or at any other time during the time I am providing temporary care for a K9 Kindness dog, will prevent me from housing a dog for K9 Kindness.

Signature: ______

Date: ______

K9 Kindness Rescue, Inc. 4209 Rodeo Road Davenport, Iowa 52806 563.391.1908