Your name:           Spouse's name:

Your occupation:          Spouse's occupation:

Address:

How long at this address?

E-mail address:

Phone (Home)   (Cell)   (Work)

Driver's license state/number:

About your home:

Check all that apply:

House      Mobile      Apt/Condo      Own      Rent

Mgrs phone#

Other occupants:  Adults #     Children # Ages?

Yard size:    Type of fence:    Lock on yard gate? Yes   No

Current Pets:

  Breed Age Gender Spayed/Neutered Licensed Vaccinated
Pet 1

 

  Male  Female  Yes  No Yes  No  Yes  No  
Pet 2

 

  Male  Female  Yes  No Yes  No  Yes  No  
Pet 3

 

  Male  Female  Yes  No Yes  No  Yes  No  
Pet 4

 

  Male  Female  Yes  No Yes  No  Yes  No  

Have you taken canine obedience classes? Yes   No

Are you able to keep your foster dogs away from your pets if necessary? Yes  No  Not Applicable

Are you familiar with possible behavior problems in rescue dogs? Yes  No

Will you work with your rescue dog to correct these problems? Yes  No

Veterinarian:

Name:      Phone #

May we contact your vet for references?   Yes  No

Why do you want a foster Dachshund and how will you care for it:

Why do you want to foster a rescued Dachshund?

Do you know the temperament and characteristics of the Dachshund? Yes  No

Where will the dog be kept?  (Day)  (Night)

Have you ever been charged with a Animal Control violation? Yes  No

Do you have a:    Dog door? Yes  No         Dog run?  Yes  No   
                            Dog house? Yes  No      Dog crate? Yes  No

# of hours dog will be alone per day?

May a LVDDR representative visit your home? Yes    No

Your signature: (type your name to sign")       Date: