Canine Foster Home QuestionnaireQuestionnaire for fostering dogs and puppies through Pet OverPopulation Prevention. Applicant's InformationDate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name First Last I am 18 years of age or older* Yes NoAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email Your Home and FamilyWhat type of home do you live in?*HouseCondoApartmentDuplexOtherDo you rent your home?* Yes NoDo you have a fenced yard (how tall?)Please list the names and ages of other people in your householdAre all of the members of your household agreeable to fostering a dog/puppy?* Yes NoDo you have any special skills or experience that may help you as you foster?Your Personal PetsWhat pets currently share your home with you? Please share names, ages, gender, breeds (and species if other than dog or cat)..Are all of your dogs & cats spayed/neutered? If not, why?*Are your pets current on their vaccinations and are you willing to provide proof of vaccination? If not please explain.What is the name of your veterinarian? Can we call them to verify your pet's vaccination reccords?*By providing this information, I understand that a POPP representative will be calling to confirm that my pets are spayed/neutered, current on their vaccinations according to my veterinarians health recommendations.If you have cats, are they kept:IndoorOutdoorBothNo catsFoster PreferencesI am interested in fostering:* Select All Adult Dogs (1-7 yrs.) Juvenile Dogs (6 m. – 1 yr) Senior (7+) Puppies (1-2) Mama + litter of puppies Neonatal puppies (bottle babies)What size of dog would you be willing to foster? Small (-25 lbs) Medium (26-60 lbs) Large (61-100 lbs) X-Large (101 + lbs)What breeds would you not foster?Are you able to keep your foster pet contained at all times (on leash, in a fenced yard, etc.)?It is safe to assume all the dogs that enter our program need basic training (potty training, basic manners, crate training, etc.). Do you feel comfortable teaching these basic skills to your foster? Yes No I have little experience, but I am willing to learn!We are happy to supply everything you need to care for your foster. Do you agree to feed your foster dog a commercial made pet food? Yes NoAre you willing to crate train your foster dog? Yes NoAdditional InformationAre you interested in fostering primarily to find your next pet? Yes NoAre you willing/able to transport fosters to veterinary appointments (flexible days/times, unless critically ill or injured) or adoption events as needed?* Yes NoDo you have a way to keep your foster separate from other animals in your home (at least temporarily)?* Yes NoHow many hours per day will your foster dog be home alone?Will you be able to keep your foster indoors for the duration of it's stay with you?* Yes NoAre you willing to crate your foster dog when you aren't home?Do you agree to keep your foster dog as an indoor pet? Yes NoDo you feel comfortable helping a foster work through minor behavioral quirks?* Yes No I am willing to learn!Do you have any questions for us or other notes about what types of dogs might work best for you?Consent and ReleaseMarking the following boxes in this section serves as an electronic signature. If you have any questions prior to completing this form please feel free to call our office (509) 943-4722 or send us an email to email@example.comI agree to submit proof that the pets in my home are spayed/neutered and current on their vaccinations according to my veterinarian's recommendations. I will keep their vaccinations up to date to protect the health of my own pets as well as the health of the foster pets in my care.* I agree I do not agreeI agree to submit photos of my home and yard as part of the approval process* I agree I do not agreePhotos can be emailed to firstname.lastname@example.orgI am willing to allow a POPP representative to do a home visit (by appointment).* I agree I do not agreeRelease Form* I agree– I understand that POPP makes every effort to screen foster animals before placement, but there are no guarantees regarding temperament or health. Foster animals could potentially injure or damage members of my family, my own pets, my belongings or my home. – I agree that my foster animals are ultimately the property of POPP and all final decisions regarding the ultimate disposition of the pet are made by POPP. Any potential adopters are subject to our standard screening process. – I agree that if my foster pet is lost, injured or ill, I will notify POPP personnel as quickly as possible. I understand that all veterinary procedures must be approved by authorized POPP representatives. – I understand that the handling of dogs on the behalf of POPP could result in damage to me or my personal property. While POPP makes an effort to screen pets prior to foster placement, there are no guarantees relating to the pet’s health or behavior. I understand that I receive foster pets at my own risk and can return them with resonable notice to the foster/adoption coordinator. – On behalf of myself, and my heirs, personal representatives and assigns, I hereby release, discharge, indemnify and hold harmless POPP and its directors, officers, employees, adoption partners (such as PetSmart and PetCo.), and agents from any and all claims, causes of action, and demands of any nature, whether known or unknown, arising out of in connection with my volunteer activities on behalf of POPP.CommentsThis field is for validation purposes and should be left unchanged.