FOSTER HOME SCREENING

Name of Volunteer/Dog’s Primary Caregiver: __________________________________________________

Address: _________________________________________________________________________________

Daytime Phone: ______________ Evening Phone: _____________ Best time to contact: _______________

E-mail: ________________ Fax: ________________

Emergency phone (give name & phone): _______________________________________________________

Please list any other adults living in household: _________________________________________________

Please list names and ages of ANY children who either live with you or visit you on a regular basis (include any grandchildren or other relatives): _______________________________________________________________________________

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Names, ages, spay/neuter status, species (dog, cat, etc.), & breed of ALL pets in your household:
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How does your dog(s) react to other dogs? (friendly, submissive, growls, etc.): _______________________

Are ALL dogs in your household current on ALL recommended and/or required vaccinations? Yes/No
Please list approximate dates of last vaccination:
Rabies ________________ DHLPP _______________ Other (Bordetella, Lyme, Giardia) ___________

Name, address, & phone of current Veterinary Clinic and/or Veterinarian: __________________________________________________________________________________________
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Have you ever had a dog diagnosed and/or treated for heartworms? Yes/No If yes, please explain: __________________________________________________________________________________________
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Do you own/rent? Live in (circle one): House Townhouse Apartment Duplex Trailer Other __________________________________________________________________________________________

Do you have the landlord’s permission to have a dog over 50 lb.? Yes/No

Landlord’s name, address, & phone number: __________________________________________________________________________________________

Do you have a fenced yard? Yes/No What type of fencing, and height of fence? ______________________

Do you allow your dog(s) to run in any unfenced areas? Yes/No If yes, please explain: __________________________________________________________________________________________
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Is anyone home during the day? Yes/No If not, where will the dog be kept during the day? __________________________________________________________________________________________

If no one is home during day, about how many hours will the dog be left alone? ______________________

Where will the dog be kept during the day? ____________________________________________________
During the night? __________________________________________________________________________

Are you familiar with crate training? Yes/No

Do you have a crate available for use with your foster dog? Yes/No

What type of dog training experience do you have? ______________________________________________

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Are you aware that your foster dog may chew, dig, bark, jump, or display other undesirable behaviors while in your care? Yes/No

Have you ever taken an obedience course with a dog? Yes/No Is your dog(s) obedience trained? Yes/No

Are you willing to work with your foster dog in areas such as basic obedience and house training? Yes/No

Have you had any experience in introducing new adult dogs into your household? Yes/No If yes, please describe how this was accomplished: ______________________________________________________________________________
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Are you familiar with the concept of who in the household is Alpha, or top dog? Yes/No If yes, please describe your understanding of who Alpha is: ______________________________________________________________________________
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Should a disagreement or fight occur between your own dog(s) and a foster, how would you handle the situation? What actions would you take to avoid this situation? Please be as detailed as possible in your response. __________________________________________________________________________________________
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Are you willing to supervise any children around your foster dog AT ALL TIMES? Yes/No

Please describe the type(s) of foster dogs you are willing to have in your home, i.e. seniors, puppies, adults, male, female, special need dogs (those who may be deaf, blind, recuperating from surgery, or with medical disorders such as epilepsy, low thyroid, etc.): __________________________________________________________________________________________
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How many dogs are you willing to foster at one time? (on occasion there may be a pair who need to remain together if possible): _________

Is there a preferred activity level for a dog you would want to foster? ______________________________

Please describe your level of experience as a dog owner, and provide an honest assessment of your abilities to recognize and deal with any problem behaviors a foster dog might exhibit (i.e. barking, growling, possessiveness of food or toys, chewing, digging, jumping, lack of house training, etc.).
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**Submission of form does NOT guarantee placement of a foster dog through

Golden Recovery Retrieving Retrievers Rescue ~ Midwest **

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Volunteer’s Signature Date

Mail to:  GRRRR Midwest

             2801 SE 4th St.

             Blue Springs, MO  64014