First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Cell Phone*

What is your date of birth?*

Occupation*

Spouse's Name

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home?*

If you rent, have you received the approval of your landlord to have an animal
Choose one: Yes No

If you rent, please enter your landlord's name and phone number

We require our shelties to have a fenced yard, is your yard fenced?

What type of fence*
Choose one: Privacy Chain Link Invisible

What is the height of the fence*

Please list Past and Present Pets and what happened to them*

Are/Were your pets spayed or neutered?*

Veterinarian's Name and Phone Number*

May we call your vet?*

Where will your sheltie be kept when you are not home*

Where will your sheltie sleep at night?*

What are your volunteer interests?

What other volunteer interests do you have?

If your interest is in fostering what type of Foster Dog would you be willing to work with?

What size foster are you willing to work with

Temperament:

Do you have an age preference?

Activity Level?

Do you have an interest in fostering another breed, other than a Sheltie

Vet Reference checked by

House/Fence check by

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