• How long have you been involved with dogs/cats?
  

• List breeds you've had experience with:
  

• Do you have any special training or experience that you wish to mention?
  

• Dogs/Cats already in your household (List breed, sex, altered):
  

• Other pets in household:
  

• Are your pets spayed/neutered?
   Yes    No
• If no, why?
  

• Are your dogs/cats on heartworm & flea preventative?
   Yes    No
• If no, why?
  

• How many children are in your household?
  
• What are their ages & sex?
  
• Other people & animals with whom the dog/cat must interact:
  

• Do you have a fenced yard?
  Yes    No
• What is the height of the fence?
   4 feet
   5 feet
   6 feet
   N/A

• Describe your fence (type, construction, etc.)
  

• If you don't have a fence, where and how will the dog be exercised and allowed to eliminate?
  

• How many & what sex of dogs/cats will you foster at one time?
  

• Length of time you are willing to foster?
  

• Will the dog live in the home?
  Yes    No

• Crates or kennels (describe):
  

• References:
• Veterinarian:
Name
Business Name
Phone

• Referred by:
Name
Home Phone

• Additional Comments: