Name of applicant
Name of co-applicant
Street
address
City
State
Zip
Home
phone
Work
phone
Cell Phone
Email
address(es)
Best time and method of contact
Applicant occupation and work schedule
Co-applicant occupation and work
schedule
Information About Your
Household
Please list all members
of your household, excluding pets. Indicate names & ages.
Please list all
pets (dogs, cat, birds, etc.) of your household (names, ages, breeds, genders).
Do any elderly or physically challenged
family members live with you or visit frequently?
Yes
No
Do you live in a...
H ouse? Yes
No
Yes
No
Yes
No
Condominium? Yes
No
Trailer? Yes
No
Do you have a fenced yard? Yes
No
If yes, what type and height of fence?
Do you have a dog door? Yes
No
Information About Your
History With Pets
Will this be your
first dog to foster?
Yes
No
Will this be your
first Golden Retriever to be guardian over?
Yes
No
What
other breed of dogs have you been the caregiver for?
If a pet has died that has resided in your household within the last
15 years, please explain when, at what age, and under what
circumstances. Please include an explanation for each pet that has
died.
Have any of your dogs had heartworms? Yes
No
If you have had pets in the past, please
provide the name, address, and phone number for the vets you have
used in the past.
Information About The Care Of Your Foster
Please answer all questions below. The answers will help us to
determine which dog might be the best foster placement for you and your
family
Do
all members of the family want to foster? Yes
No
Why do you want to foster?
Why do you think you would be a good caregiver for a Golden?
What age
foster fits with your lifestyle and expectations?
Please explain.
Are you
aware that Golden Retrievers are very active?
Yes
No
Are you aware that Goldens shed year-round?
Yes
No
Are you aware that Goldens are large dogs and may jump-up on children and
the elderly?
Yes
No
Is there anyone in your home who may be adversely affected by dogs
(e.g., due to allergies)? Yes
No
If so, please explain.
Who will care for and exercise the dog?
Is anyone home during the day?
Yes
No
If so, who and what age?
How long will the Golden normally be left alone each day?
Where will the Golden be kept during the day when no one is home?
Would you
consider a special needs dog, such as one who requires medication for a
permanent, but controlled, condition?
Yes
No
Information About The
Post-Application Process
When are you able to
start fostering a Golden?
May we visit your home prior to application approval? Yes
No
Please indicate the best day of the week and time during the day that you
and your family would be available for a home visit.
May we contact your veterinarian? Yes
No
If so, provide name and contact information of most recent vet(s).
Please list two
references (other than your vet), their relationship to you and their
contact information.
I/we attest that the information provided on this application is true and
accurate to the best of my/our knowledge. I understand that any
misrepresentations of fact may result in the removal of the foster dog
from my home by GRRH. The undersigned
(hereafter referred to as “the volunteer”) has agreed to volunteer his/her
services or facilities to GRRH. The volunteer(s) acknowledges and
understands that the dogs involved in the GRRH program may be untrained or
unhealthy, and that GRRH makes no representations whatsoever regarding the
dog’s temperament, health (including the presence or absence of diseases
transmissible to humans or to other animals), age, ability, attitude,
trainability.
The volunteer assumes all risks relating to working with the GRRH dog(s).
The volunteer hereby releases GRRH, its officers, directors, participants,
volunteers, and affiliates (“GRRH” Participants) from any and all claims,
actions, liabilities, damages, and costs of any kind (claims and costs)
arising out of transportation, fostering, or any other work or activity
with any dog connected with GRRH or a dog owned by GRRH volunteer. If
anyone in the volunteer’s household makes a claim, the volunteer will
indemnify, defend, and hold GRRH and the GRRH participants harmless from
such claims and costs. Volunteer hereby authorizes GRRH to contact the
references or veterinarian contacts given in this application.
Applicant's Name
Date
Co-Applicant's Name
Date
Thank you for your interest in
providing a loving foster home for a GRRH Golden
Retriever.
Thank you for opening your home and your heart to a rescued Golden!
