| Name and Age |
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| Email Address |
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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 be contacted |
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| Occupation |
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| Hours worked per week |
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HOW
WOULD YOU LIKE TO HELP US IN RESCUE?
CHECK
ALL BOXES THAT APPLY
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| Foster |
Long
term? (until adopted)
Short
term? (one week maximum) |
Transport?
(pick up from shelter and deliver to rescue)
Assist
at adoption events
Surf
Internet sites to see what dogs are available for adoption
Call
shelters to check availability dates, holds, etc.
Scout
shelters? (this requires driving to shelters and checking out the dogs
seen/heard about on Internet)
Release
from shelters and temporarily hold until transport to foster person can
be arranged?
Home
visits? (visiting potential adoptive homes)
Reference
checks? (calling references to verify information provided by potential
adopter)
Follow
up calls and visits? (to adoptive home)
Public
Relations/Advertising? Fund
Raising? Web
Assistance/Maintenance? |
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| Other - please specify |
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| What, if any, is your
dog experience? |
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| WHICH SHELTERS
ARE YOU WILLING TO SCOUT?North Central
South Central
Downey SEAACA West
Valley East
Valley Carson Camarillo Lancaster Baldwin
Park Inland Long
Beach Orange
County Riverside San
Bernardino |
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| Other |
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| Hours per week you can
devote to volunteer? |
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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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HISTORY
OF PET OWNERSHIP
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| Do you personally own
a Lhasa Apso, Shih Tzu, Maltese or Pomeranian? |
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 dogs currently
live in your household? (please list)
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| Do you have any other
animals? If yes, Please list |
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Please list dogs
you have owned in the past 15 years and explain what happened to the dog
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ABOUT
YOUR HOME
(FOR
FOSTERING ONLY)
Check
here to skip:
|
|
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 have any covenants or restrictions on pet ownership? |
Yes No |
| If yes, please explain |
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| Does your town or city
have any restrictions on the number of dogs you can have? |
Yes No |
| If yes, how many? |
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| Do you have a yard? |
Yes No |
| Is your yard, or a portion
of your yard, securely fenced and with what type of fencing? |
|
| If you have a pool is
it fenced? |
Yes No |
| If you have a dog run,
is it secure? |
Yes No |
PREFERENCES
(FOR
FOSTERING ONLY)
Check
here to skip:
|
|
| How many dogs would you
consider fostering at one time? |
|
| Do you have a separate
quarantine area or an area you could keep a dog quarantined if necessary? |
Yes No |
| If not, how do you plan
to keep the dogs separate? |
|
| Are you willing to foster
dogs with special medical needs? |
Yes No |
| 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? |
|
| Do you have any other
preferences or restrictions? |
|
Care
and responsibility
(FOR
FOSTERING ONLY)
Check
here to skip:
|
|
| Will you be able to take
the foster dogs to a groomer? |
Yes No |
| Will your groomer offer
you a discount? |
Yes No |
| Cost |
|
| Are you prepared to do
the necessary routine care like cleaning out the eyes, ears, etc.? |
Yes No |
| Approximately how many
hours will the fosters be left alone? |
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| Where will the fosters
stay when you are away? |
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| Where will the fosters
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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| Are members in the family
willing to help you foster? |
Yes No |
| Will you allow the fosters
to mingle and socialize with the family and pets after the quarantine period? |
Yes No |
| REFERENCES: Please
provide three names including your vet and a groomer (if you have one).
Other references could include a neighbor, co-worker, friend or relative
who owns a Lhasa or other high maintenance breed. (if fostering one must
be a vet reference) |
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| Please enter any comments
or questions here: |
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| I acknowledge
that all the information contained on this form is true & correct.
I understand that any misrepresentation of fact may result in the removal
of the adopted dog from my/our home. I am aware that I must notify a LHASA
HAPPY HOMES 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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PLEASE CLICK
SUBMIT BUTTON ONLY ONCE
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