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Dog Foster Application

Foster

1Applicant

2Family

3Home

4Care

5Preferences

Name
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First Name*
Last Name*
eMail Address*
eMail Address Confirm eMail Address
Street Address*
Suite | Apt or Unit Number
City*
State/Province*
ZIP*
Country*
Home Phone Number
Work Phone Number
Cell Phone Number*
Can we text you at this number?*
- Yes
- No
Preferred Method of Contact*
Employment & Schooling
- Are You Employed?*
  - Yes
  - No
  - Retired
- Full or Part Time?*
- Name of Employer
- How Long Employed There?
- Are You In School?*
  - Yes
  - No
- Full or Part Time?*
- How Did You Hear About Us?*
- What Is Your Friend's Name?*
- Which Shelter?*
- Which Rescue?*
- Please Describe*

- Type of Residence*
- Please Describe Type of Residence*
- Do You Own or Rent?*
- Does Landlord Allow Dogs?*
  - Yes
  - No
- Are There Any Breed Or Size Restrictions?*
- Please Provide Landlord's Name*
- Please Provide Landlord's Phone Number*
- Does your home have stairs?*
- Please select the amount of stairs/levels*
- What material are the stairs*
Yard Information
Do You Have A Yard?*
- Yes
- No
Is The Yard Fenced?*
- Yes
- No
Tell us about your fenced areas*
Please tell us about your fenced area*
How High Is The Fence?*
What Is The Lowest Point of The Fence?*
What Material Is The Fence Made From?*
Please Describe Fence Material*
Is The Lawn Treated?
- Yes
- No
Do You Have A Pool?*
- Yes
- No
Is The Pool Completely Fenced?*
- Yes
- No

Family & History
- What Type Of Household Do You Have?*
- Please Describe*
- Do All Family Members Want to Foster A Dog?*
  - Yes
  - No
- Please Explain Who Doesn't and Why They Don't*
- Is Any Member Of Your Household Allergic To Dogs?*
  - Yes
  - No
- Does Any Member Of Your Household Smoke?*
  - Yes
  - No
Sleep & Alone Time
- Where Will The Dog Sleep?*
- Where Will The Dog Be When Alone?*
- Do You Have A Doggie Door?*
  - Yes
  - No
- Is It Locked When You Are Away From Home?*
  - Yes
  - No
- If You Are Gone From Home During The Day, Does Someone Let Your Dogs Out?*
  - Yes
  - No
- What is The Longest Time The Dog Will Be Alone (without humans)?*
Behavior & Training
- Dogs Can Take A Month Or Longer To Adjust To A New Home, Particularly If Other Pets Are Involved. Are You WIlling To Devote This Much Time To Make The Dog Comfortable In Your Home?*
  - Yes
  - No
What Behaviors Can You Tolerate (AND WORK ON)?
Needs Social Skills*
Accidents In The House*
Excessive Barking*
Separation Anxiety*
- Other
  - Yes
  - No
- Please Explain Other Behaviors You Cannot Tolerate*
- What Are Your Plans For Training The Dog?*
- Please Describe Your Training Plans*
Personal Reference
Please Provide Reference's First Name*
Please Provide Reference's Last Name*
Please Provide Reference's Phone Number*
Please Provide Reference's eMail Address*
Relationship To Applicant*
Years Acquainted*
Veterinarian Information
Have You Used A Veterinarian Before?*
- Yes
- No
Please Provide Veterinarian's Name*
Please Provide Veterinarian's Phone Number*
Foster Care
Please describe any experience or special training you have that may help you evaluate personality and temperament:*
Please describe any experience or special training you have had that may help you to understand and deal with potential problems a rescue dog may have:*
Are you willing to foster a dog with medical needs which may require trips to a veterinarian?*
- Yes
- No
Are you able to transport your foster dog for veterinary care during typical office hours (9-5)?*
- Yes
- No
- Possibly
Tell us more...*
Can you transport in the evenings before/after an appointment to a volunteer that can do the driving?*
- Yes
- No
Will you need a volunteer to do all driving to/from veterinary appoitnments?*
- Yes
- No
Are you willing to foster a dog who may need training for behavior problems?*
- Yes
- No
The foster dog shall be kept safe and walked on a leash/harness when outside unless in a fully-fenced area.*
- Yes
- No
Do you understand that any foster dog entrusted to your care must be provided adequate food, water, affection, socialization, training, exercise and medical care?*
- Yes
- No
Do you understand that the Rescue and its representatives have limited information about the temperament and habits of the rescued dog?*
- Yes
- No
Do you agree to provide the Rescue with an assessment of the dog’s interaction with the potential adoptive family and give an impression of the likely success of such adoption?*
- Yes
- No
Are you willing and able to evaluate the personality and temperament of a foster dog to determine the best type of adoptive home? i.e. a home with children; adult home only; home with other animals; needs to be an only dog, etc*
- Yes
- No
Are you willing to foster a dog who has been abused and/or neglected who may require special attention and lots of love and reassurance?*
- Yes
- No
Do you understand that no decisions may be made regarding veterinary care (including euthanasia,) or placement without the prior approval of the Rescue?*
- Yes
- No
Do you understand that under no circumstances will a foster dog be used for breeding?*
- Yes
- No
Are you able to submit pictures, notes and updates at least one-time a week, either through the web application, text, email or social media?*
- Yes
- No
Do you understand that if the foster family finds it can no longer keep the dog in their care, they shall notify the Rescue immediately?*
- Yes
- No
Do you understand that the foster family must ensure that the rescued dog is not allowed to run loose, injure or be injured by another animal or by any person?*
- Yes
- No
Do you agree to cooperate in accommodating those who wish to see the rescued dog?*
- Yes
- No
Is there anything else you would like to tell us about the care you would give a needy foster dog?

What Breeds Would You Consider Fostering?
Pure-Bred Pug*
French Bulldog*
Boston Terrier*
Chihuahua*
English Bulldogs*
Any Small Breed (Shih Tzu, Pekis)*
Small Pug-Mixes (Under 20 lbs)*
Medium Pug Mixes (20-30 lbs)*
Large Pug-Mixes (Over 30 lbs)*
A Mixed Breed Dog*
Would You Consider Fostering
Select all that apply.
A Blind Dog?*
A Deaf Dog?*
A Dog with Special Mobility Needs?*
A Dog that is Diabetic or Epileptic?*
A Dog that is Incontinent?*
A Dog that is not 100% Potty Trained?*
A Dog that has Behavioral Needs?*
A Dog that has Bitten Before?*
A Dog on Hospice Care?*
Two Dogs?*
A Puppy or a Litter of Puppies?*
A dog that may require middle of the night feeding or medication?*
Do you have any Foster Limitations?*
When Will You Be Ready To Foster?*
Is There Anything Else You Would Like to Let Us Know?
Just in case you decide you want to adopt your foster pup
In the event the foster family wishes to permanently adopt the rescue in their care, an Adoption Application must be submitted and an Adoption Placement Contract must be signed. Repuglickin' loves when our fosters decide to adopt so we have no problems with this at all! We're just taking a moment to share the process.*
- YAY!
- Sounds good
Are you OK with the adoption donation fees published on the Repuglickin' website for Pugs & Pure-Breed Flat-Faced dogs like Frenchies: Under 1: $800-$1000; 2-3: $600-$800; 4-5: $500-600; 6-8: $300-$500; 9+: $100-$300.*
Just making sure you know that our adoption fees are adjustable based upon health of the dog. The adoption donation for many pug-mixes and non-pug breeds are often between $100-$500, based upon age and health of the dog.*
Confidentiality Agreement
If disclosed, do you agree to keep all personally identifiable information (PII) of the original owner private (e.g. surrender contact information)? (For the purpose of this agreement, the term "PII" refers to any information obtained as a volunteer in any capacity, through Repuglickin' Buzz System or any private facebook pages or told verbally by any Foster, Adopter or administrator for Repuglickin'. For the purpose of this agreement, the term "confidentiality" will be considered sharing (in any forum/manner) with other than Repuglickin' volunteers.)*
Do you agree to use all information provided to you through the Repuglickin' rescue management software and any associated facebook groups for the intended purpose only (e.g. facilitating care and adoption of dogs in rescue)? (For the purpose of this agreement, the term "PII" refers to any information obtained as a volunteer in any capacity, through Repuglickin' Buzz System or any private facebook pages or told verbally by any Foster, Adopter or administrator for Repuglickin'. For the purpose of this agreement, the term "confidentiality" will be considered sharing (in any forum/manner) with other than Repuglickin' volunteers.)*
Do you agrees to refrain from any public disparagement, defamation, libel, or slander of surrender owners, adoption applicants or any other contact or application received through the Repuglickin' rescue management software. (For the purpose of this agreement, the term "PII" refers to any information obtained as a volunteer in any capacity, through Repuglickin' Buzz System or any private facebook pages or told verbally by any Foster, Adopter or administrator for Repuglickin'. For the purpose of this agreement, the term "confidentiality" will be considered sharing (in any forum/manner) with other than Repuglickin' volunteers.)*
I am interested in receiving pet related services and products
- Yes
- No
Authorization
Authorization:*
I agree that any rescue dog from Repuglickin' will reside with me in my home as a foster dog. I will provide it with adequate food, water, shelter, training, affection and medical care provided by Repuglickin's Veterinarian. I agree to take the foster dog for any medical care needed or coordinate with Repuglickin' Rescue Admins to help coordinate transport. Iunderstand all appointments, medical care recommendations made by Veterinarian and medicine refills need approval of Repuglickin' Rescue Admins PRIOR to proceeding with treatment. I agree Repuglickin' is in no way liable or responsible for any damage, accident or injury resulting from placement of a foster dog in my household. I agree if the foster dog is not compatible in my household that I will contact Repuglickin' Rescue Admin to have the rescue dog go to another foster home. I certify that I am at least 18 years old. I understand that I will be volunteering at my own risk and that the rescue, its Board of Directors, other volunteers, employees and affiliates, cannot assume any responsibility for any liability for any accident, injury or health problem which may arise from any volunteer work I perform for the rescue. I understand and agree *
- I agree

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