First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

County

Email*

Cell Phone*

What is your partner's name?*

I live in a

Which best describes your residence?*
Choose one: I own my apartment I rent my apartment I live with roommates in an apartment I own my condominium I rent my condominium I live with roommates in my condominium I own my house I rent my house I live with roommates in a house

If you rent, have you received the approval of your landlord to have an animal*
Choose one: Yes No

If you rent, please enter your landlord's name and phone number*

Does your home have stairs inside or out? How many approximately?*

Do you have a fenced yard?

What is the height of the fence*

What type of fence*
Choose one: Privacy Chain Link Invisible

What size or age of dog do you prefer to foster?*

Is there a breed type you do not want?*

Are you willing to work with a dog that is not housebroken?*

We prefer you crate train your foster dog, is this a problem? If so why?*

Can you take a pregnant mom or a mom with puppies?*
Choose one: Yes No

Would you be willing to foster a special needs dog? If yes, what would be your preference ie. blind, deaf, paralyzed?*

We occasionally need end of life Hospice homes, would you be interested in this? *
Choose one: Yes No

Will the animal be kept inside or outside*
Choose one: Inside Only Outside Only Inside and Outside

How much time will the animal spend alone during the day*

What other pets do you have? Please list species, breed, and age.*

Are pets in home spayed or neutered (no will not exclude fostering/adopting) If no, give reasoning*

Please list the names and ages of children in the home*

Do any children, under 8 years old, visit your home frequently?*

How did you hear about Res-Que?

List at least one reference (who is not a family member)*