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About You
You must be 21 years of age and the primary individual to
be responsible for the foster |
| Name and Age: |
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| e:mail Address: |
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| Spouse/Partner: (Fostering Only) |
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| Street Address: |
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| City, State, Zip: |
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| Home Phone: |
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| Work Phone: |
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| Cell Phone: |
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| Best time to contact you: |
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| Occupation: |
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| Hours per week you can volunteer? |
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How would you like to help us at Amazing Aussies
Check all boxes that apply |
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Foster? |
Long Term? (until
adopted)
Short Term? (one week
maximum) |
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Transport? (pick up from
shelter and deliver to rescue)
Assist at adoption
events?
Call Shelters to check
availability dates, holds, etc.?
Home visits? (visiting
potential adoptive homes)
Follow up calls? (to
adoptive homes)
Public Relations
Fund Raising |
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Other - please specify: |
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History of Pet
Ownership |
| Do you currently
have an Aussie? |
Yes
No |
| If yes, describe: |
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| If not, how much
knowledge do you have about the breed? (Please explain) |
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What pets currently live in
your household? (Please list) |
| Name |
Breed |
Gender |
Age |
How long |
Spay/Neuter |
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Yes
No |
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Yes
No |
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Yes
No |
| Do you have any
other animals? If yes, please list: |
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Preferences
(For Fostering Only) |
| Are you willing to
foster dogs with a history of neglect/abuse who need extra love and
attention? |
Yes
No |
| Are you willing to
foster dogs with behavior problems who require special training? |
Yes
No |
| What restrictions
would you have about fostering a dog? |
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| Do you have any
other preferences or restrictions? |
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Care and Responsibility
(For Fostering Only) |
| Will you be able to
take the foster dog for veterinary/eye care appointments? |
Yes
No |
| Are you prepared to
do the necessary routine care such as eye drops, daily medication,
etc.? |
Yes
No |
| Approximately how
many hours a day will the foster be left alone? |
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| Where will the
foster stay when you are away? |
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| Where will the
foster sleep at night? |
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| How many people
currently live at your residence? |
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| Are there children
and if so, what are their ages? |
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| What, if any, is
your dog experience? |
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| What, if any is your experience with
special needs dogs, ie: deaf or blind? |
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| What would be the
thing or things you would like to do to help if you had your choice? |
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About Your
Home
(For Fostering Only) |
Which of the
following best describes your current residence? (check one)
Own a single family
home Rent/lease a
single family home or duplex
Own a townhouse or
condominium
Rent/lease an
apartment, townhouse or condominium |
| Other - please
explain |
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| Does your lease or
Homeowners Association (HOA) have any covenants or restrictions on pet
ownership? Written permission is required from
HOA or landlord prior to fostering. |
Yes
No |
| If yes - please
explain: |
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Do you have a yard? |
Yes
No |
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Is your yard, or a portion of
your yard, securely fenced and with what type of fencing? |
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How high is your fence? |
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Do you have a dog door? |
Yes
No |
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If you have a pool is it fenced? |
Yes
No
No
Pool |
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If you have a seperate dog run, is it
secure? |
Yes
No
No
separate run |
| Are all members of
the family in agreement to foster? |
Yes
No |
| Will you allow the
foster to mingle and socialize with the family and pets? |
Yes
No |
| Would you be willing
to let a representative from Amazing Aussies visit your home for a
home check? |
Yes
No |
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References:
Please provide three names including your vet. Other
references could include a neighbor or co-worker. (If
fostering, one must be a vet reference.) |
| Name |
Phone Number |
Relationship to
applicant |
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| Please enter any
additional comments or questions have here: |
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| I
acknowledge that all the information contained on this form is true
and correct. I understand that any misrepresentation of fact
may result in the removal of the fostered dog from my/our home.
I am aware that I must notify Amazing Aussies within 24 hours if the
situation should arise in which I can no longer keep the animal, or
if it appears that the animal is lost or stolen. Please date
and type name in the area below, this serves as your signature. |
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Name: |
Date: |