*Applications are only accepted from persons living in northeast Ohio

Date:

Your Name:

Phone:   Home Work Cell

Email Address:

Address:

City, State, Zip:

Please check all that you would be interested in fostering:

Variety:  Standard                     Miniature                Toy   

Gender:  Male          Female       Either 

Age:  Puppy to 4 yrs old          4 – 8 yrs old         Senior (8 yrs +)         Any age

Would you consider a Special-Needs poodle?   Yes No  

Would you consider a pair?    Yes No

Please state the names, relation and ages of all individuals residing in your home: 

                  Name                                                               Relation                                                      Age                         

or       N/A 

Have your children been raised with a dog?      Yes No             

Describe your residence:       House            Apartment/Condo 

                                                  Own                 Rent  

Please state the names, ages and kinds of pets that are currently in your home:      

             Name                                            Kind of Pet/Breed                                               Age              Spayed/Neutered?

             Yes No

             Yes No

             Yes No  

             Yes No

 or       N/A 

What types of animals have you lived with in the past?   Cats          Dogs        Other

Are all of your current pets up to date on vaccinations?        Yes No

Veterinarian’s Name

 Vet Clinic: 

 Veterinarian’s Phone Number

Where will the dog be kept during the day?

Where will the dog be kept during the night? 

Will the dog have the run of the house?    Yes No

Will the dog be allowed on the furniture?    Yes No   

Will you use a crate?    Yes No  

How will the dog be managed when outside?

       Fenced yard      Chained         Leash       Dog Pen

Can you provide food and basic supplies for your foster dog?    Yes No      

Will you be willing to sign a Volunteer Release/Liability Waiver prior to receiving an

animal to foster?           Yes No