Date___________
Name of Applicant_________________________________________________________ (must be at least 18 yrs. of age)
Street Address_____________________________________________________________
City, State, Zip____________________________________________________________
Phone(___)______________ Email:__________________________
Name of co-applicant_______________________________________________________
Relationship: (circle choice) spouse / parent / child / roommate / other________________
Applicant's employer________________________________________________________
position____________________________________Phone(___)____________________ _
Co-applicant's employer_____________________________________________________
position___________________________________ Phone(___)____________________
1. Please explain why you would like to foster:__________________________________ ___________________________________________________________________________
1a. Check what you can foster: sick ____Injured____ Healthy_____ Nursing Mother & Pups_____Behavioral/temperament problems ____ such as:
1b. How many dogs can you foster at one time?_____
Do you understand that most foster animals need daily medication, special feedings, veterinarian care and lots of love and attention? Can you provide the time necessary to care for this animal until it is able to be adopted? _______________________________________
The Wrinkled Rescue agrees to pay for approved medical treatment. If the foster is in the immediate area medical care will be at Kingston Veterinary Clinic. Do you have any concerns with this? If so please explain:___________________________________________
Are you willing to give this pet time to adapt to his/her new environment and family members ( at least 30 days)?____________________________________________________
Do you understand this animal may not be housebroken and are you willing to take the time to work with the animal?___________________________________________________
Obedience training might be determined necessary for the animal you foster. Would you be willing to do the necessary training which might include taking it to obedience/ behavior classes? (the rescue would cover reasonable cost for this training )(Training for dogs would be at training centers approved by Wrinkled Rescue only.)____________________________
2. Where do you live? (rent___ own___ live with parents___) circle one: house ___/ townhouse ___/ apartment___/ condo___/ duplex___/ mobile home___/ other___ ( please explain).
Are there any covenants (restrictions) that prevent you from having a pet?________________________________________________________________________
2a. How long at this residence?_____
3. Do you have permission from this property owner to have a dog?_______or ______not applicable. (Proof of ownership, or lease with pet clause may be requested.)
3a. If renting, please provide your landlords name, address and phone number: ___________________________________________________________________________
4. Where will this pet be kept while you are away or at work?_______________________
At night?_________________________________________________________________
5. Is anyone home during the day?____who?_____________________ how long? ______
Do you work full-time/ part-time?_____ hours?________________work two jobs?______
6. How many hours will this pet be alone per day?_______________
7. How many adults live in your home?________, children________, their ages_________
8. Who will be responsible for the care of this animal? ____________________________
9. We require that all animals adopted from us be spayed/neutered.
Do you have any questions or reservations about this policy? _________________________________________________________________________
10. Who will care for this animal while you are on vacation? _______________________
11. If you have to move, what will you do with this animal? ________________________
12. How long are you willing to take responsibility for this pet? (6 mo, 1 yr, until adopted, or other) ___ ________________________________________________________________
13. How much do you think it will cost to care for this pet each year? _________________
Consider the cost of veterinary care, food, licensing, boarding, etc...__________________
14. What will you do if the pet gets sick?________________________________________
15. Will this pet be taken annually to the veterinarian for rabies, distemper, hepatitis, leptospirosis, parainfluenza, and parvovirus inoculations, and be checked for parasites and heartworms? ________________________________________________________________
16. How will you control fleas/ticks? __________________________________________
17. Will this pet be kept on heartworm control year round?_________________________
18. Please list all pets you have owned in the last five years:
Breed/Name Sex Age spayed/neutered Where is it now?
Current on Vaccinations?____________________________________________________
19. If you have ever had a pet die at an early age or in an accident, please explain. _______________________________________________________________________
20. Do you have fencing ( a totally enclosed, secure yard)?__________________________
Please describe (type of materials and height, amount of space) or how do you plan to exercise the dog?
_______________________________________________________________________20a. How will the dog be confined while out of doors?_____________________________
Do you plan to tie or chain the dog out at anytime? If so, please explain:_______________
21. How will you handle: excessive barking?_____________________________________
_______________________________________________________________________excessive chewing?________________________________________________________
toilet training?_____________________________________________________________
22. May Wrinkled Rescue Volunteers arrange to visit you in your home to discuss the Chinese Shar-Pei? __________________________________________________________
23. Do you have a veterinarian? _____ May we contact them?___________
Name___________________________________________________________________ ___
Phone (___)______________________________________________________________
24. Please tell us how you found out about our rescue. ______________________________________________________________________
25. Are you interested in joining the Central Ohio Chinese Shar Pei Club?____________
I ACKNOWLEDGE THAT ALL THE INFORMATION CONTAINED ON THIS FORM IS TRUE AND CORRECT, AND I AGREE TO THE TERMS AND CONSIDERATIONS SET FORTH IN THE FOSTER APPLICATION COVER LETTER. I UNDERSTAND THAT ANY MISREPRESENTATIONS OF FACT MAY RESULT IN THE REMOVAL OF THE FOSTER DOG FROM MY HOME BY WRINKLED RESCUE!
Applicant signature_____________________________________Date_____________
Co-applicant signature_____________________________________Date_____________
Thank you for taking the time and effort in filling out this application. We feel that it will help all involved in the placement process. Again, our non-profit organization only desires seeing these wonderful dogs placed in loving homes and given a second chance. Thank you for your interest in providing homes for our wrinkled "Pei-Mates"!
For Office Use Only:
Date received__________ Date assigned____________
To whom__________________Phone________________
Results__________________________________________________________