First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone*

Type of Dwelling*
Choose one: House Apartment Condo

Type of Yard*
Choose one: Unfenced Chain Link Wooden No Yard

Do you*

If renting, please provide your landlord's contact information

If you own, are you a part of a homeowner's association?

If you are part of a homeowner's association, please provide a brief explanation of the by-laws pertaining to dogs

Name, gender and age of all family/household members*

Have any members of your family/household been charged with cruelty or neglect to animals?*

Please provide the name, relationship and phone number for three personal references

Personal Reference 1:*

Personal Reference 2*

Personal Reference 3

Have you ever volunteered for any other organization?*

If so, please provide the organization name, contact details and dates of service

Please provide your Veterinarian's name, clinic name and phone number*

If you use more than one Veterinarian, please provide their details as well

Please list all animals with ages currently living in your home*

If you currently have animals, are they up to date on vaccinations?

If you currently have dogs, are they up to date on heart worm preventative?

Additional comments and/or special circumstances ABTRR should be aware of (if none, please enter "N/A")*

I understand that: If I am volunteering to foster, I am aware that foster dogs are not prescreened. Fostering means that I am willing to take on a health/behavioral/training challenged dog just for the sake of the dog. There is not a specific timeframe for fostering. Sometimes a dog is with the foster family for a few weeks or months, but it can be years, or my home may be the only home that dog will ever know. *

I give permission for ABTRR to contact my personal and veterinary references as well as the organizations I have previously or currently volunteer for. *

By entering your name and date below, you are electronically signing this document.*