Name:
Address:
City, State, Zip:
Telephone, Fax:
E-mail address:
Why do you want to foster?

Do you rent or own your own home? Rent Own If renting, please attach proof (lease) that your property manager approves of you having a pet in your residence and that it does not violate your rental agreement.
Do you have transportation? Yes No
Do you prefer an inside dog, an outside dog or an inside/outside dog?
Where will this dog be kept during the day?

Where will this dog be kept at night?

Do you have a fenced yard? Yes No. If yes, please describe the enclosure.
How many hours a day are you away from home?
Do you travel frequently? Yes No
Will you have time to teach a foster dog some basic manners? Yes No
How many adults are in the household?
How many children are in the household? What are their ages?
Does anyone in your household have allergies to animals? Yes No
Who will be the primary caregiver?
Please list the animals that currently reside with you. Include what breed and sex they are, their age and whether they are spayed or neutered.

If you have family dogs, can you provide proof of vaccination? Yes No
Are they on hearworm preventative? Yes No
Please provide the name and phone number of your vet. Remember to include the area code.
Would you object to us contacting your vet? Yes No
Describe the type of dog you would like to foster (large, medium, small, length of hair, age...)

Would you object to a home visit by a Pekes and Pals representative? Yes No
How did you hear about Pekes and Pals?

I understand that this organization cannot guarantee the health, temperment or training of the foster dog, and I hereby release Pekes and Pals Canine Rescue, Inc. form all liability once the dog is in my possession.

Signature of applicant: _____________________________________ Date _____________________