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Foster Application

About You:
Name:	Email: (name@domain.com)
Date of Birth :	Do you have any prior experience in dog rescue? If yes, please explain:
Why do you want to foster? :
Home Telephone:(include area code) Best Time to Call:	Work Telephone:(include area code) FAX:(include area code)
Address: City/Town: State/Prov.: Zip Code: We work only within Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont. Applications submitted from outside these states cannot be considered.
Driver's Licence #:	State License Issued :
Occupation:	How long employed with current employer? :
Spouse/Significant Other's Name:	Spouse/Significant Other's Occupation:	How long spouse employed with current employer? :
List any Humane Societies, Organizations, Breed or Training Clubs you are associated with:	How did you hear about Northeast Pekingese Rescue? :
Are you currently working with any other Rescues? :	If yes, please provide the name, phone number and email address so we may collaborate our efforts:

About Your Home:
Which best describes your home? :	If other, please explain :
Do you live in:	Do you own or rent your home? :	How long at current address (years/months) :
If you rent, do you have permission from your landlord to participate in our rescue program?:	What are the requirements of dog ownership in your community? (i.e., licensing, rabies, leash laws, and number of dogs you may legally have):
Is your yard fenced in securely for a dog? :	If yes, is dog yard:	Please provide specific measurements :
Do you have a cable or kennel run? :	If yes, please provide describe cable run or provide specific kennel run measurements:	If no to fenced yard, cable or kennel run, how will exercise/toilet be handled? :
Do your neighbors have pets? This includes people next door, across the street, and in your immediate surroundings such as your block. :	If yes, please provide information as to type including whether it is a cat or dog, breed, size, temperament, if it is an outside or inside dog, etc.:
How many adults in house? :	Please list names and ages of each adult in your home:
Any children in the home? :	Please list names and ages of each child in your home:
Is there anyone in your home with animal related allergies? If so, please explain:	Is there anyone in your home with a disability or special needs that we should be made aware of their condition? :

About Your Other Pets:
Do you own any dogs? :	If yes, are they spayed or neutered? : If not, why? :
Any other pets/livestock? :	List names, breed, age and sex of each of your current pets (cats, dogs, etc.): Pet #1 : Pet #2 :
How many dogs have you owned in the last 5 years? :
In the event that your pet(s) & foster(s) do not get along with each other, what measures will you take? :
If you've owned a dog in the past, what happened to him/her? : Please explain circumstances for above and please provide specifics, including name of dog, breed, and any other pertinent specifics: If your last dog was given away, please indicate the name and address of the person to whom the dog now belongs:
Are all of your animals (dogs and cats) current on all vaccinations? (DHlpp, Bordetella and Rabies) : If not, why? :		Are all of your animals (dogs and cats) on heartworm preventative? : What type? :(please specify)

About Pekingese:
Have you owned or fostered a Pekingese before? :
Why are you interested in fostering a Pekingese? :	How have you educated yourself about the Pekingese breed? Please specify:
List your life activities in which you would enjoy including your foster dog:	Would you accept a Peke mix? :
If you would require a specific gender or age please specify: Sex: Age:

About Medical Concerns:
A. Would you consider a special needs dog, such as one that requires daily medication or one that is deaf? :	B. Would you consider fostering a dog with a disability? :
C. Would you consider fostering more than one dog at a time? :	D. What is the oldest age you would consider fostering if any? :

About Living Environment:
Where will dog spend most of each day? :	If indoors: Please provide specifics on your answer provided above:	If outdoors: Please provide specifics on your answer provided above:
Who will be in charge of the daily care of the dog? :	Who will care the dog during vacations? :	If you don't usually use a crate, will you be willing to use one if you get a dog that is used to being crated? :
Is someone home at all times or will the dog need to be alone for a portion of the day? :	If someone would take the dog out during day, is it:	Please explain your choice above and please be specific by describing your work hours, etc.:
What will you do if the dog is destructive while left alone? :	Where will the dog sleep? (Please check all that apply): Crate Dog Bed Family Member's Bed Basement Garage Fenced Yard Outside Shelter Kennel Dog House	Please provide specifics as to dog's sleeping environment to support your answers above:

About Exercise and Discipline:
How would you exercise the dog? :	What is your definition of disciplining a dog? Please provide examples:
Are you willing to attend obedience classes with the dog? :	Have you ever obedience trained a dog before? :
What are your thoughts on Obedience training? :	List the types of behavior problems you consider NOT acceptable:

About Food and Expenses:
How much do you think it would cost to feed the dog on a weekly basis? (Please explain):	What kind of dog food would you feed the dog?:	If other (please specify):
Please indicate brand name you will feed the dog:	What would the dog's eating schedule be?:	Plans for Dog:
Who is your veterinarian:	Vet's Address:	Vet's Telephone (include area code):
If no regular vet, would you like a referral?:

Miscellaneous:

How long can you keep a foster dog in your care?

What would you do if you could not keep the dog? Please be specific:

Do you understand that in fostering a dog, you can not permanantly adopt the dog without complying to adoption procedures?

Do you agree to the following:
Return dog to Pekingese Rescue if you can no longer keep or care for dog at any time in the future?
Allow NEPR agent to visit your home prior to fostering? :
Allow interested person(s) comes to your home to look at the dog? :

Please provide 3 personal references (not related to you):
Name	(Area Code) Telephone #	Relationship to applicant	Yrs known



Your Signature (only if mailing or faxing)		Today's Date
Would you consider joining NEPR as a transport volunteer?
When you click on the buttons below, you are stating your agreement and compliance to our application process. By checking this box, you have indicated that this is a valid and legal substitution for your written signature on this legal document titled "Pekingese Foster Application". By checking this box, you are stating that you are able to care for a foster dog beyond the assistance from the Rescue Program. By checking this box, you understand that if the information contained herein is found to be false, your application can be refused or said dog in your foster care shall be relinquished to Pekingese Rescue without a refund of monies paid. IMPORTANT: Print out a copy of your application in case you experience any computer problems. If you get an error message after you hit the submit button, try refreshing/reloading the page. If that doesn't work, hit the back button on your browser, then click the submit button again. Your information is about to be sent via unencrypted/unsecured email. If you do not wish to have your information transmitted in this way, please click "Edit" & "Select All" from your browser and copy and paste the information to an email and send to applications@nepekerescue.org or print and mail to: NEPR, Inc. PO BOX 11 Dover PA 17315 Please click "Submit" button only once. Please be patient after hitting submit button, it may take a few minutes to receive confirmation message on your screen.

Questions or Comments? Email us! Info@NEPekeRescue.org

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