Havanese Angel League Organization for Rescue

Application for Fostering/Quarantining a Havanese

Many of our rescues come from puppy mills and usually are not accustomed to living inside a house. Fostering or quarantining a puppy is just like having a regular puppy in your home but having a little older Hav might mean the dog is not used to house sounds: phone ringing, dishwasher running, washer/dryer in use, microwave beeping, vacuum cleaner appearing to "attack", people reaching to pick-up or hold him, plus NOT BEING HOUSEBROKEN! With all that said, we'd love for you to submit a fostering application to volunteer with HALO.

INFORMATION ABOUT YOU AND YOUR FAMILY
Name
Address
City, State & Zip
Home Phone #			Work Phone #
Best Time to Call			E-mail Address
Occupation			Your Age
Please complete the following for each additional person living in your household on a regular basis:
Name	Age		Relationship	Occupation
Who will be caring for the dog?
Is everyone listed above in agreement on being a foster family? YES NO (explain)
If you look after children, adults, daycare, run a business from home, please explain the circumstances:
ABOUT YOUR HOME (please circle)
Apartment Condo Single-family house Townhouse Trailer How long at address?
Do you RENT OWN		If renting, does landlord permit a dog? YES NO
Do you have a balcony? NO YES If yes, the space between the rails?
Would you be willing to make adjustments in your home for the safety of the rescued Hav? YES NO
Is your yard fenced? YES NO Size of yard:
If YES, please specify the approximate height and type (chain link, privacy, invisible, other)
Landlord Information (if applicable)
Name	Company		Address	Phone #

INFORMATION ABOUT YOUR FUTURE FOSTER HAVANESE
Do you prefer a MALE FEMALE NO PREFERENCE Age Preference:
Have you fostered a dog before? NO YES, please explain when & where
Would you foster a dog that was not housetrained? YES NO
Would you foster a dog with behavior or temperament issues? YES NO, please explain
Do you have experience with dogs in the following areas (check all that apply):
Housebreaking	Abused/neglected	Aggression	Other (specify)
Puppymill dogs	Physical handicaps	Shyness
Where will the foster dog spend the day (check all that apply)
Loose indoors	Garage	Outside kennel run	Crate
Loose outdoors	Basement	Tie-up outdoors	Other (specify)
Where will the foster dog spend the night (check all that apply)
Loose indoors	Garage	Outside kennel run	Crate
Loose outdoors	Basement	Tie-up outdoors	In bed with family
How many hours per day will foster be alone?		Is someone usually home during the day?
Who will care for the dog in your absence?		What are your work hours?
When you are away on vacation, etc., what arrangements will be made for the foster?

QUARANTINING A RESCUED HAVANESE:
Quarantining is different from fostering. Most of our rescues are obtained from puppy mills and we take extra precautions for their health and that of your own family pets. This means that before the fostering begins, we require the dog to be quarantined. This means that the dog is completely isolated from any animals you may own: confined to a separate room, no interaction with your pets, potty outside in a controlled area, washing hands after each handling. Taking the dog to the vet for medical tests is very important. Our dogs are brought up-to-date on necessary shots, brucellosis tested, treated for fleas or ear mites, etc. It would be helpful if you could take the dog for this care; HALO will pay for all medical expenses. The quarantine period lasts two-three weeks. Based on this information, would you be able to quarantine a rescued Havanese? YES NO MAYBE
YOUR HISTORY WITH CATS
Have you owned cats? YES NO		How many cats have you owned in the past 10 years?
Describe what happened to the cats no longer with you.
Do you currently own any cats? YES NO		Are they indoor or outdoor cats? INDOOR OUTDOOR
How do your cats relate to dogs?		Any other comments?
Other Pet Information – Do you currently own any pets other than dogs or cats? YES NO
Name	Type		Age (weight if applicable)
How do they get along with dogs?

Additional Information About You:
Have you ever surrendered an animal to a shelter/rescue, given a pet away, etc? NO YES WHY?
Do any of your current pets have characteristics that a Havanese should be aware of? NO YES, please explain
Veterinarian & Medical Information: Please provide the following for the veterinarian who can confirm vaccination, heartworm testing, spay/neuter verification for your current pet(s). If you don’t have a pet, please provide the vet who cared for your previous pets if applicable.
Name: Clinic Phone:
Address
Do you agree that a HALO representative may visit your home? YES NO
Please provide 2 references (only one can be a relative) who are familiar with your home, family and interaction with pets.
Name	Relationship	Phone Number & best time to call

Havanese Angel League Organization for Rescue (HALO) reserves the right to refuse or deny any fostering application. By signing and dating below, you agree that all the information listed on this application is complete and truthful. Also, by signing and dating below, you authorize HALO to verify the information on this Application for Fostering form. Any misrepresentation will be grounds to automatically reject the application.

Print your name:

Your Signature:

Date:

Upon receipt of this application, a HALO representative will contact you for an in-depth interview based on this information. Your references and vet will be contacted. In this organization the animal and its needs come first. Thanks for your time in completing this form. Please mail this application to:

HALO Rescue Inc.

P.O. Box 367

Manteno, Illinois  60950.

THANK YOU FOR YOUR INTEREST IN VOLUNTEERING TO HAVANESE ANGEL LEAGUE ORGANIZATION FOR RESCUE

We appreciate the time you took completing the foster/quarantine application.