ADR
FOSTER HOME APPLICATION
Please send completed form to:
Box 60
Lousana Ab. T0M 1K0
Please fill form out in black or blue ink. Use extra paper if required. We ask that you please consider each question carefully as the information you provide assists us in assessing the type of dog we can place in your care.
PERSONAL INFORMATION:
Today’s Date: ________________________________________________________________
Name: ______________________________________________________________________
Street: ______________________________________________________________________
City: ___________________________ Province: ___________ Postal Code: _________
Home Telephone: ________________ Work Telephone: _____________________
Employer: ____________________________________________ May we contact you at work?
Email Address: ________________________________________
COMPANION ANIMAL INFORMATION AND HISTORY:
Have you had pets in the past? If so, please describe.
Do you have pets currently?
Please list pets you currently have in your home. Include the following information in your list. Type/Breed; sex; age; owned since; comments on personality of each animal. Please attach an extra sheet if needed.
Are your pets spayed/neutered? If no, please explain.
What are your personal beliefs on spaying and neutering?
Are your pets up-to-date on vaccinations?
*The name and phone number of your veterinarian are mandatory*
Veterinarian’s Name:
Address:
Telephone Number:
How long have you been associated with this vet and/or clinic?
You will need to call ahead and give permission for vet ref. to you vet.
Would your pets accept a new dog?
Do you have any male dominant or female dominant pets in your home?
Where are your pets kept during the day or when no one is at home?
Where do your pets sleep?
Where are your pets when you are at home?
If you travel, what arrangements do you make for the care of your pets?
HOUSING INFORMATION:
Do you own _________ or rent _________, a house ________, apartment ________ or condo _________?
*If renting, please provide landlord’s name, address and telephone number. We require written consent stating that you are permitted to have a foster dog on the premises. Please include this consent with your completed application*
Landlord’s name:
Address:
Telephone:
ADR has a total restraint policy. Do you have a securely fenced yard? Dachshund proof?
What type of fencing? (please describe in terms of material and height)
If you don’t have a fence, are you willing to fence, install an exercise run or leash walk at all times? Please indicate which of the above would apply to you.
YOUR FAMILY
How many adults are in your home? ________ Children _______
Names and ages of people living in your home
1.
2.
3.
4.
5.
Is everyone living in your home agreeable to having a foster dog/cat?
Do other children visit your home?
How would you describe the activity level of your household? i.e. quiet, structured, busy, hectic etc….
What are the working hours of the adults in the household?
Who would care for the foster dog/cat when the adult(s) are not home?
If the child is under 12 years of age, would you provide constant supervision of the child/dog and never leave them unattended together?
Does anyone in your home have allergies? Please describe.
THE FOSTER DOG
** Dachshunds vary greatly in temperment, personality and activity level. Please keep this in mind as you fill out this section and provide us with as much information as possible and carefully consider your answers **
Have you ever owned/lived with a Dachshund or applicable breed?
What characteristics would you use to describe a Dachshund or applicable breed?
What characteristics would you find desirable in a foster Dachshund or applicable breed?
What characteristics would you find undesirable in a foster Dachshund or applicable breed?
Would you accept a dog/cat that is:
Older?
Has been abused?
Not reliable with children?
Has behavioural issues?
Partly or not housetrained?
Has physical disabilities/handicaps?
Has separation anxiety?
Exhibits fear aggression?
Is pregnant or whelping?
Has dominance issues?
Has a strong prey drive?
Is recovering from a medical condition?
How long would you expect your fostering term for any one dog to last?
Would you be willing to foster the dog until a permanent home is found?
Many rescue Dachshunds have problems with fearfulness, fear aggression, separation anxiety and housetraining to name a few. Would you be willing to help retrain a dog following a specific behavioural remediation program that included support from a trained professional?
Have you ever housebroken a puppy or dog?
How would you approach housebreaking a dog? Please explain in detail.
What forms of discipline do you feel are appropriate for training or modifying behaviour in a dog?
Would you be willing to transport a foster dog to veterinarian appointments?
Comments or Questions? Please feel free to include any information that you feel we should know about you, your family, your experience with pets. Also include any concerns or questions you may have regarding fostering or our organization.
REFERENCES:
Please provide us with at least two references in addition to your vet. We are looking for individuals who can provide us with information about your suitability as a foster home.
Please provide full name, telephone number(s) and relationship for all references
Reference #1
Reference #2
By signing this document:
I understand that the Alberta Dachshund rescue will be responsible for any medical, training or other approved expenses associated with the foster animal in my care. Note: If injuries or medical treatment is required as a result of negligence on the part of the foster home; the foster home will be held responsible for covering the costs of treatment. INITIAL _________
I also understand that by signing this form I agree to release and covenant to hold harmless ADR, and its members from any claims, damages, costs, or actions incurred as a result of the foster care or actions of the foster animal.
I will notify ADR immediately should the foster animal become lost, stolen, ill or die.
I agree to contact my ADR representative at least once per week to update her/him on the condition and well-being of the foster animal.
ADR strongly discourages training or behaviour modification through physical violence of any sort. We will not condone nor tolerate hitting, ‘spanking’ or any other form of physical punishment.
The foster home agrees to provide quality food for the foster animal at their own expense. Treats, toys, beds etc…. are also the responsibility of the foster home. The Rescue will try to help with these incidentals wherever possible.
ADR reserves the right to perform unannounced visits to the foster home at any time.
ADR reserves the right to take the dog off the premises at any time. Note: If ADR judges the foster animal to be in danger, this signed document releases ADR to remove the animal from said premises without warning. INITIA L ________
The Foster /Representative understands that if accepting an animal into rescue as an agent of ADR, that animal becomes the legal property of ADR regardless . Any pulling, approved vetting fees, or adoption fees paid for out of pocket have been done so as an agent of ADR and does not entitle the Foster/Representative to ownership of said animal. These expenses will be reimbursed by ADR upon receipt of said animal. INITIAL ___________
The foster home understands that ADR cannot predict the behaviour of any animal in any situation. ADR will provide any relevant information on the animal’s history and temperment that is known. This information may or may not be a reliable indicator of how the animal will behave in a new environment; including your home.
I certify that I am at least 21 years of age and that I will be solely responsible for the care and well-being of any dog that I foster for ADR. Any misrepresentation of the true facts in this application will invalidate the foster home agreement and will give ADR the right to immediately reclaim the foster dog.
Signature __________________________________________ Date ______________________
