Foster Home Application
If you wish to foster dogs for Houlas & Heelers Inc., please complete this form. After you have completed the application and submitted it, please be patient – it may be at least several days before you hear back from a representative. This Application is not a contract or an agreement.
Applicants must be 18 years or older.
Applicant’s Name: ______Age: ______
Date of Birth (MM/DD/YYYY): __ / __ / ____ Last 4 Digits of SSN: ______
Home phone:______Work phone:______Cell phone:______
Street address:______
City/State/Zip:______
Best time to call:______Your occupation:______
E-mail:______How often do you check e-mail?:______
How long have you been involved with dogs?______
List breeds with which you’ve had experience:______
How many and what sex of dogs will you foster at one time?______
Length of time you are willing to foster:______
Children/other member of household, list ages and sex:______
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Other people and animals with which the dog must interact:______
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Any people in the household have pet allergies? If yes, which:______
What are your daily activities and hobbies? Tell us about yourself:______
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Home Information
Are you located in the city, suburbs or a rural area?:______
Is it a house, apartment or condominium?______
Do you rent or own?:______How long?:______
If you rent are dogs allowed?Yes______No______
If so, how many dogs and what weight?______
Landlord name and contact information (include phone and address):______
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If you own, are there any ordinances limiting the number of pets?Yes______No______
If so, how many pets may you have?______
Do you have plans to move from this location?Yes______No______
Do you have many encounters with children?Yes______No______
Do you have many encounters with joggers?Yes______No______
Do you have many encounters with bicycles?Yes______No______
Do you have many encounters with neighborhood dogs?Yes______No______
Do you have many encounters with cats?Yes______No______
Do you have many encounters with dog parks?Yes______No______
Do you have a fenced yard?Yes______No______
Type of fence:______Fence height:______Size yard:______
What type of training methods/collars do you use? (Be specific):______
______
If your foster dog is not housetrained, what methods will you use to housebreak him/her ? (Be specific):
______
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Animal Care Information
Name of current pet #1:______Spay/Neutered:______
Breed:______Sex:______Age:______
Name of current pet #2:______Spay/Neutered:______
Breed:______Sex:______Age:______
Name of current pet #3:______Spay/Neutered:______
Breed:______Sex:______Age:______
Name of current pet #4:______Spay/Neutered:______
Breed:______Sex:______Age:______
What happened to your previous pets? Please be detailed:______
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______
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Who is the primary caretaker?:______
When you are home, the dog will be: In the yard?______In the home?______Other:______
Please explain:______
When at work or away from home, the dog will be: In the yard?______In the home?______
In the crate?:______With you?:______Other:______
Please explain:______
Home alone hours: 1-2 hrs.:____2 – 4 hrs.:_____4-6 hrs.:______6 – 8 hrs.:_____8+ hrs.:______
Will the dog be allowed in your home?Yes______No______
What is your opinion on dog crating? Please be detailed:______
______
Crate or kennel (describe):______
Amount of time per day and when dog(s) will be crated or kenneled? Please be detailed:______
______
How do you plan to keep this dog on your property when it is outside?: Fenced Yard:_____Fenced Run/Pen:______
Invisible fence:______Shock collar:_____On a leash:____Other:_____
Please explain:______
How will you exercise the dog?______
______
Any other activities for the dog?Yes______No______
Will you enroll the dog in obedience class?Yes______No______
How will you care for the dog if you have to be away (vacation, work travel, etc.)?______
______
What is you expectation for adjustment for your new dog?______
What is your opinion of Invisible Fences and Shock Collars? ______
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Do you use either on your current pets or have used on past pets/fosters? ______
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What brand of food will you feed? (or anticipated)______
______
How do you respond to pressure?______
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Explain how you would react to this scenario: “You had a horrible day at work and you come home only to find that your foster dog chewed a hole in your couch, tipped the garbage over and dragged the contents throughout the house and urinated in your bed…”
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Do you like working with the public? What do you think is your greatest strength?______
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How are you as a communicator?______
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Additional comments or questions?:______
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References
Veterinarian’s Name:______Phone number:______
Street address:______
City/State/Zip:______
Referred by:______Phone number:______
Personal reference #1:______Phone number:______
Street address:______
City/State/Zip:______
Personal reference #2(Non-Family Member)______Phone number:______
Street address:______
City/State/Zip:______
In consideration of Catahoula Rescue of New England hereinafter the "Corporation's", acceptance of my services as a Rescue Volunteer, Foster Home, or Special Volunteer, I agree that I, my assignees, heirs, distributees, guardians, and legal representatives forever release and shall not make a claim against, sue, or attach the property of the Corporation, its officers, directors, volunteers, committee members, members, employees, agents, heirs, successors and assigns for any actions, causes of actions, suits, liabilities, claims, demands,
damages or causes of any kind or nature whatsoever, whether presently existing or arising in the future, whether known or unknown, which arise out of or are based upon any fact, matter, claim or thing involving my services as a volunteer. I agree to indemnify and defend the Corporation, its officers, directors, volunteers, committee members, members, employees, agents, heirs, successors and assigns against and save them harmless from any and all demands, claims, causes of action, or judgments, and any and all expenses (including, without limitation, attorney’s fees) incurred in investigating or resisting the same, for injury to person, loss of life, or damage to property occurring during the term of my services as a Rescue Volunteer, Foster Home, or Special Volunteer, and until all applicable statutes of limitation expire, arising out of any act, omission, or neglect of the Corporation, its officers, directors, volunteers, committee members, members, employees, agents, heirs, successors and assigns.
By submitting this application, I declare that all of the above information I have given is true and complete.
Applicants’ signature*:______Date:______
*Typed name indicated acceptance and agreement to above statements.
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30 Clements Pt Rd ∙ Warren , ME ∙ 04864(P) 207-273-2713 (C) 207-975-2909 (email)