Seniors for Seniors Foster Applicant’s Personal Information  

Please fill this out very carefully and pay close attention to the questions.

Full Name 

Date of Birth   Home Phone # 

Street address   

City, State and ZIP

Work Phone #      Cell Phone # 

What is the best time for us to call? 

Email address  

Employer’s name/address  

Spouse's Name:  

Spouse's Employer:

I reside in a  house apartment mobile home condo   in     town the country a subdivison a community    with     no neighbors close neighbors distant neighbors next door neighbors in a shared structure

Number of adults in home 

Number of Children      Ages: 

Do all adults in household consent to this adoption?  No Yes  

Are there any smokers or visitors or guests to the home who smoke?  Yes No Occasionally

Are you/spouse a student?  Yes No    Do you travel frequently?  Never Seldom Frequently Constantly  

If yes, how often   

Who will be there to take care of your dog while you travel?

What experience with dogs does this person have and will they actually be living there or will they be

making stops during the day while you’re gone?   

How often will they visit and/or check up on the dog? 

Does anyone living in your home have allergies or asthma?  Yes No

If so, who?

Do you have a fenced yard with a lockable gate? No Yes

Type of fence and height:

How long have you been at your current address and names of next door neighbors:

Do you plan to move in the next 12 months?  Yes No

If so where:   

If you do move, what will you do with your dog? 

If renting, does your landlord allow pets? No Yes  

Name & telephone number of landlord 

Deposit required and amount per dog 

Do you plan to keep this dog mostly inside or mostly outside, always inside or always outside?   

Where will the dog be kept during the day?  

Where will the dog be kept during the night?  

Where will the dog be kept when nobody is home ?  

How long will the dog be left home alone during the day or night and how many days per week?  

Do you often work overtime? 

What provision will you make for exercising your dog and how often?

What provision have you made for the dog to take care of “personal business” during rain, snow or other inclement weather and how often?

Where will the dog sleep at night? 

Do you own a dog carrier/crate and if not, do you plan to purchase one?  

(We generally recommend crating your dog while you are away from your residence as a precaution to the dog’s safety)

Do you plan to chain this dog in the yard?   (type "yes" or "no" without quote marks):   ?

Can you keep this dog away from the other pets for one week other than supervised "visits"   No Yes ? 

(Unless the posting states “NO OTHER PETS”  we recommend this time to allow all household pets to become accustomed to each other)

Why do you want to foster a Boston Terrier rather than another type of dog

Do you have children or plan on having  Yes No ?

Is the dog’s appearance/size/age/sex important to you and if so, why 

If the dog develops a health problem who will take the dog to the vet ?

?  

How will you know when to take the dog to the vet?

If the dog develops a behavior problem, how will you deal with it?

Comments:

List three personal references (no relatives) that you have known for at least a year.  Provide names, addresses and phone numbers.  

First Personal Reference (non family related), address, phone number and best time to call:

Second Personal Reference (non family related), address, phone number and best time to call:

Third Personal Reference (non family related), address, phone number and best time to call:

Type in the Anti-Spammer Security Code number 1333 below :

I, swear or affirm that all the information of this application is true and correct.  I further swear or affirm that nothing has been withheld that would adversely affect my consideration in adoption of a Boston Terrier or any other dog and that nothing in my background might disallow me from being considered in adoption of a dog or any other animal.  I swear or affirm that this dog is for my own personal enjoyment and is expected to be my dog and that I am not making this application for any third person or organization or group.

I further swear or affirm that I have never been prosecuted, successfully or unsuccessfully on animal cruelty or similar charges AND that I have never been refused by any other Rescue or Adoption Agency or Shelter or similar organization adoption of a dog or any other animal.  

I acknowledge that I have read, understand and agree with this entire application document including the Introduction, MINIMUM REQUIREMENTS/QUALIFICATIONS FOR ADOPTION and Notes.

 (signed)

Date: