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FullName and Age |
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Email Address |
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Street Address |
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City, State, Zip |
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Home Phone |
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Work Phone |
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Cell Phone |
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Best time to be contacted |
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Occupation |
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Hours worked per week |
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HOW WOULD YOU LIKE
TO HELP US IN RESCUE?
CHECK ALL BOXES THAT APPLY
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Other - please specify |
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What, if any, is your dog experience? |
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WHICH SHELTERS ARE YOU WILLING TO SCOUT?
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Other |
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Hours per week you can devote to volunteer? |
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What would be the thing or things you
would like to do to help if you had your choice? |
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HISTORY OF PET
OWNERSHIP
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Do you personally own a Lhasa Apso,
Shih Tzu, Maltese or Pomeranian or other small breed dogs ? |
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If yes, describe |
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If not, how much knowledge do you have
about the breed? (please explain) |
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What dogs currently live in your household?
(please list)
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Do you have any other animals?
If yes, Please list |
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Please list dogs you have owned in the
past 15 years and explain what happened to the dog
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ABOUT YOUR HOME
(FOR FOSTERING
ONLY)
Check here to
skip:
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Which of the following best describes
your current residence? (Check one)
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Other (please explain) |
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Does your lease or homeowners association
have any covenants or restrictions on pet ownership? |
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If yes, please explain |
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Does your town or city have any restrictions
on the number of dogs you can have? |
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If yes, how many? |
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Do you have a yard? |
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Is your yard, or a portion of your yard,
securely fenced and with what type of fencing? |
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If you have a pool is it fenced? |
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If you have a dog run, is it secure? |
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PREFERENCES
(FOR FOSTERING
ONLY)
Check here to
skip:
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How many dogs would you consider fostering
at one time? |
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Do you have a separate quarantine area
or an area you could keep a dog quarantined if necessary? |
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If not, how do you plan to keep the
dogs separate? |
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Are you willing to foster dogs with
special medical needs? |
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Are you willing to foster dogs with
a history of neglect/abuse who need extra love and attention? |
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Are you willing to foster dogs with
behavior problems who require special training? |
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What restrictions would you have about
fostering a dog? |
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Do you have any other preferences or
restrictions? |
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Care and responsibility
(FOR FOSTERING
ONLY)
Check here to
skip:
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Will you be able to take the foster
dogs to a groomer? |
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Will your groomer offer you a discount? |
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Cost |
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Are you prepared to do the necessary
routine care like cleaning out the eyes, ears, etc.? |
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Approximately how many hours will the
fosters be left alone? |
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Where will the fosters stay when you
are away? |
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Where will the fosters sleep at night? |
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How many people currently live at your
residence? |
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Are there children and if so, what are
their ages? |
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Are members in the family willing to
help you foster? |
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Will you allow the fosters to mingle
and socialize with the family and pets after the quarantine period? |
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REFERENCES:
Please provide three names including your vet and a groomer (if you have one). Other
references could include a neighbor, co-worker, friend or relative who owns a Lhasa
or other high maintenance breed. (if fostering one must be a vet reference) |
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Please enter any comments or questions
here: |
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I acknowledge that all the information
contained on this form is true & correct. I understand that any misrepresentation
of fact may result in the removal of the adopted dog from my/our home. I am aware
that I must notify a LHASA HAPPY HOMES within 24 hours if the situation should arise
in which I can no longer keep the animal, or if it appears that the animal is lost
or stolen. Please date and type name in the area below, this serves as your
signature. |
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PLEASE CLICK SUBMIT BUTTON ONLY
ONCE
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