House of Paws Dog Rescue
Kannapolis, North Carolina 28083

First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

When is the best time to call you?*

How long have you lived at your current address?*

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

If yes, what kind and how tall?

Place of employment and work phone*

What are the occupations of other adults in the household? Retired? Stay at home parent?*

List all adults living in the home, and their relationship to you.*

List all children in the home, and their ages. (If none, write none)*

What type of home do you live in? *
Choose one: single family town home apartment mobile home farm

Do you own or rent your home? *
Choose one: Own Rent Live with family

If you rent, please give the rules governing pets and the landlord’s name and number: (by providing this information you are allowing us to contact your landlord. Please inform them of this call so they will speak with us)

Where will the pet be kept during the day?*

List all pets currently in your household and the ones you have had in the past 5 years (Name, Breed, Spayed/Neutered?, Age , What happened if you no longer have them?)*

Are your dogs vaccines up to date?*
Choose one: Yes No Not applicable

Are your dogs up-to-date on heartworm prevention?*
Choose one: Yes No Not applicable

Are all your pets spayed or neutered?
Choose one: Yes No Not applicable

How will you discipline your new dog?*

List your current and past vets (name and ph. #)*

Where will the animal be kept when you are not home*

Where will the animal sleep*

How long will the pet be left alone during the day?*

List 3 references (name and phone #)*

***THIS FORM WILL BE PRINTED OUT AND SIGNED UPON APPROVAL TO FOSTER.

All of the information I have given is true and complete. This dog will reside in my home as a pet while I am fostering him/her. I will provide it with quality dog food, plenty of fresh water, indoor shelter, and affection.

Signature

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Date

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