APPLICATION TO FOSTER

Heartland Great Dane Rescue, Inc.

We make every effort to place a dog with you that suits your lifestyle and your expectations.  ALL potential foster homes are screened for suitable placements of animals. Heartland Great Dane Rescue, Inc., may refuse placement of an animal for any reason. By submitting this application, you give permission for HGDR, to investigate and confirm the information that you provide. Application becomes the property of HGDR.

MINIMUM REQUIREMENTS:

*You must be 21 years of age or older, or have a parent or legal guardian co-adopt the dog.

*You must have your landlords consent and pay a pet deposit if one is required.

*Your pets must have current vaccinations and be free from contagious illnesses.

*You must be able and willing to spend the time necessary to provide training, medical treatment, proper care, and companionship for the pet.

 ______________________________________________________________________________________

Full Legal Name                                         DL#                              DOB

 ______________________________________________________________( )___________________

Street Address                                             City             State              Zip            Home phone

 ( )_________________________________________________________________________________

Work Phone                        Employer Name and Address

 ______________________________________________________________(_____)_________________

Spouse Legal Name              Spouse Employer                                                     Work Phone

I live in a:   House   Apartment   Mobile   Home   Condo   Other:________________

This  foster pet will be kept:   Mostly inside   Mostly outside   Totally inside   Totally outside  

Number of Adults in household:________ Number of children _____Ages________________

Do ALL of the adults in the household consent to this foster? Yes   No    

Does anyone have concerns about fostering a Dane? Who?__________What are the concerns?__________________________________________________________________________________________________________________________________________________________________

Are you or your spouse a student? Yes   No  

Do you or your spouse travel frequently? ______________If yes, how often?________________

How long will the dog be left home alone during the day? _______hours ________days a week.

Where will the dog be kept while you are at work or away from home?_____________________ Where will the dog sleep at night?_____________________________________

What will you do when you need to travel?___________________________________________

Does anyone living in the house have allergies to dogs or asthma that might make living with a dog difficult? Yes No If yes, who?________________

Do you have a fenced yard? Yes   No    Type of fence: wood chain-link Other Height? _______ft

How long at your current address?_______________ Do you own your home? Yes   No  

If you rent: Does your landlord allow pets? Yes No Is a pet deposit required? Yes No How much? $__________per pet or per household? Size/Weight limit? Yes No Limit:____ Can proof of deposit be obtained from your landlord? Yes No ______________________________________________________( )____________________ Name of Landlord Phone # (required)

Do you plan to move in the next 12 months? Yes   No   If yes, where?____________________

 PET OWNERSHIP HISTORY

 Have you ever adopted from a humane group or shelter?__________ If yes, who did you adopt from? ________________________When?_____________________

Have you ever given an animal up for adoption or gotten rid of an animal?____________ If so, why? _________________What did you do with the animal?________________________

How will you teach housebreaking?_________________________________________________ Are you willing/able to purchase and use a cage/crate if needed or advised?________________

Total number of pets currently owned: _______Dogs _____Cats ______other_______

Total number of pets NOT currently owned, but owned within the last five years?____________

Are all of the pets in your household current on their shots?_____________________________

Are all of the pets in your household spayed or neutered? ______If not, why not?____________________________

Are all of your dogs on heartworm preventative?______ What type?______________________

Have any of your household pets been diagnosed with infectious diseases in the last 6 months?_____

Do any dogs in your household have, or been tested positive for, the following diseases or conditions:

heartworms:______________Distemper_________________Parvo_____________

Veterinarian Information:

Name:

Address:

Phone:

How many times have you used this vet?

 GREAT DANE KNOWLEDGE

Have you ever owned a Great Dane or Giant Breed dog before?__________________

What do you expect to be the worst and/or hardest part about fostering a rescued Great Dane, and how do you plan to deal with/address it? __________________________________________________________________________ _____________________________________________________________________________________

Do you realize that Great Danes are BIG?______________ Do you know what bloat is?______________________________

Do you know that a Great Danes food and water need to be shoulder level?______________

Do you have a sex preference?______________ Would you be willing to foster a special needs Dane?_____________

PERSONAL REFERENCE INFORMATION

Personal Reference Information

 Name:

Address:

Phone:

How do you know this person?

Personal Reference #2

 Name:

Address:

Phone:

How do you know this person?

PERMISSIONS

Do you give permission for HGDR, representative to visit your home prior to fostering to do a home check and after to do follow up checks on your fostered Great Dane?______________

Do you give permission for HGDR, representative to contact your vet prior to fostering to do a home check and after to do follow up checks on your fostered Great Dane?______________

What date are available to begin to foster?_______________________

I confirm that all the information in this application is correct and complete to the best of my knowledge, and hereby give permission for HGDR to investigate and confirm/verify this information.

 Signature _________________________________________________________ Date______________________ Print Name_____________________________________________________