Foster Therapy/Service Dog - LittleRhodyRescue.org

Name

First

Last

Address

Phone Number

Email

Describe the type of Therapy Dog You are willing to foster

Desired Pet's Name

Occupation

How did you hear about LRR?

Vet Clinic Name

First

Last

Vet Phone #

Personal Reference

Personal Refernece Phone #

Own or Rent?

Own
Rent

Years at current address?

Selected Value: 0

Landlord Name (If Applicable)

Landlord Phone

Any Pet Restrictions?

Yes
No
Unsure

Do All Household Members Agree to Foster a Dog?

Yes
No

Any Children Under the Age of 10 in the Household?

Yes
No

Will the dog have regular contact with children under 10?

Yes
No
Unsure

Please describe the contact with the children under 10

Please list all dogs in your household, include: Name, Gender, Breed, Age, Alerted, and up to date on all vaccinations and heartworm?

How many dogs have you owned in the last 5 years?

Selected Value: 0

If you no longer have them, what happened to them?

Please list all other pets living in your home (type, name and age):

If there are no other animals currently living in your home, will your foster dog have regular contact/socialization with others?

Your preferences for a dog's energy level?

How do you plan to exercise the dog?

Are you familiar with the use of a dog crate to train and/or confine the dog during your absence or at night?

Yes
No

Are you planning to use a crate?

Yes
No

Training the therapy dog is mandatory. Do you vow to engage in required training?

First Choice
Second Choice
Third Choice

How many hours per day will your dog(s) be home without humans on a regular basis?

Selected Value: 0

Where will the dog(s) be when you are not home?

Where will the dog(s) be at night?

What will you do with your dog(s) if you need to be away from home overnight?

Would you agree to return the dog to the rescue if you were unable to keep him/her?

Yes
No

Have you ever been convicted of animal abuse? Domestic Abuse? Physical assault?

Yes
No

It is IMPERATIVE that you notify Little Rhody Rescue & Quarantine Inc. at the onset of any type of illness or health problem within thirty (30) days following an fostering. Do you promise to tend to this if there should be an illness or issue?

Yes
No

Are you aware that you are fostering a therapy/service dog that will eventually be with a designated family and you will have to part with the dog and you agree to part with the dog at that time?

Yes
No

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