Your name *

First Name

Last Name

Current Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone *

(###)

###

####

Cell Phone *

(###)

###

####

Additional person (1) living in your household on a regular basis.

First Name

Last Name

Additional person (2) living in your household on a regular basis.

First Name

Last Name

Additional person (3) living in your household on a regular basis.

First Name

Last Name

Additional person (4) living in your household on a regular basis.

First Name

Last Name

Does anyone smoke in your home?

Yes

No

Is everyone listed above in agreement on being a foster family? *

Yes

No

Has anyone living in your home ever been convicted of a criminal offence? HALO reserves the right to conduct background checks. *

Yes

No

Describe the type of your home *

Apartment

Condo

Single-Family House

Townhouse

Trailer

Do you rent or own your home? *

Rent

Own

If renting, does landlord permit a dog?

Yes

No

Do you have a balcony? *

Yes

No

Would you be willing to make adjustments in your home for the safety of the rescued? *

Yes

No

Is your yard fenced?

Yes

No

What is the name of your landlord?

First Name

Last Name

What is your landlord's address?

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What is your landlord's phone number?

(###)

###

####

Has Dog 1 been spayed or neutered?

Spayed

Neutered

No

Has Dog 2 been spayed or neutered?

Spayed

Neutered

No

Has Dog 3 been spayed or neutered?

Spayed

Neutered

No

Has Dog 4 been spayed or neutered?

Spayed

Neutered

No

Other than your current dogs described above, have you previously owned any other dogs the past 10 years? *

Yes

No

Do you prefer a male or female? *

Male

Female

No Preference

Have you fostered a dog before? *

Yes

No

Would you foster a dog that was not housetrained? *

Yes

No

Would you foster a dog with behavior or temperament issues? *

Yes

No

Do you have experience with dogs in the following areas (check all that apply) *

Housebreaking

Abused/neglected

Aggression

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

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

Is someone usually home during the day? *

Yes

No

Do you currently own any cats? *

Yes

No

If yes, are they indoor or outdoor cats?

Indoor

Outdoor

Do you currently own any pets other than dogs or cats? *

Yes

No

Have you ever surrendered an animal to a shelter/rescue, given a pet away, etc? *

Yes

No

Do any of your current pets have characteristics that we should be aware of in placing a foster with you? *

Yes

No

Vet Phone number *

(###)

###

####

Vet Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you agree that a HALO representative may visit your home? *

Yes

No

Reference 1 *

First Name

Last Name

Reference 1 Phone *

(###)

###

####

Reference 2 *

First Name

Last Name

Reference 2 Phone *

(###)

###

####

Reference 3 *

First Name

Last Name

Reference 3 Phone *

(###)

###

####

Do you know one of our adopters?

Yes

No

If yes, who?

First Name

Last Name

Today's Date *

MM

DD

YYYY