Last Name :
First Name :
First Name :
Address :
City :
Province :
Postal Code :
Phone home :
Cell phone number :
Telephone at work :
Email address :
If you are under 18, are your parents aware that you are applying? :
No
Not Applicable
Yes
How did you hear about Refuge A.M.R. :
Your home- Check the appropriate response :
Apartment
Condo
Other
Rent
Single-family home
Townhome
If Other, Specify :
Are you :
Owner
Renter
If you rent, give the owner's name and number to reach him :
Do you have a back yard :
yes no
If yes, is it a safe yard for a dog :
yes no
Is the yard fully fenced :
Please indicate the size of your yard :
If the yard is not fenced, how will you manage the needs of the dog and exercises :
How much exercise a day will you do with the dog and for how long :
How many adults are there in your house including you :
Ages :
Occupations :
How old is the primary responsibility of the family home for the dog :
How many children :
Will any members of your family be with the dog during the day? :
yes no
How many hours would the dog be alone during the day? :
If more than 8 hours, are you ready to find someone to take the dog out during this period :
yes no
Does someone at home have allergies? :
yes no
If yes, please specify who :
Is there a smoker in the house? :
yes no
Please name the age of people you frequently visit your family (Friends, family, housekeeping, etc. :
Do you currently have other dogs :
yes no
If yes, how many :
Are they spayed / neutered :
yes no
Breed (s), Gender (s) and age (s) :
How long have you had these dogs :
How did you get these dogs :
What brand of food do you use for your dogs now :
Do you give other food to your dog :
yes no
Do you have cats :
yes no
If yes, how many :
Are they neutered / spayed :
yes no
Age(s) :
How long have you had these cats? :
How did you get these cats? :
Do you have other pets? Please specify :
How many dogs have you had over the last 5 years? :
What has happened to them? :
Have you ever abandoned a dog or a cat? :
yes no
If yes, please explain the circumstances :
Have you abandoned them in a shelter, a pound or organization for abandoned animals? :
yes no
If no, please specify :
What kind of dog are you looking for? :
Female
Male
No preference
What age group? :
1 to 3 years
4 to 7 years
8 and up
No preference
Puppy
What type of hair :
Long
Medium
No preference
Short
That does not fall
How big :
Extra large (over 90 lbs)
Large (51-90 lbs)
Medium (20-50 lbs)
No preference
Small (less than 20 lb)
Energy level desired :
High
Low
Medium
No preference
Where will the dog be most of his day? :
In a cage
In the basement
In the enclosed garden
Inside-Free
Other
Outside attached
Outside free
If other, please explain :
Where will the dog spend most of the night :
In cage
In the basement
In the enclosed garden
Inside-Free
Other
Outside attached
Outside free
If other, please explain :
When your family goes on vacation or a weekend what would you do with the dog? :
If the dog or puppy shows behavioral problems* what will you do about it? :
Are you ready to work with a dog that might require some level of toilet training? :
yes no
Are you ready for a dog with special needs? :
yes no
What level of behavioral problems are you prepared to deal with? :
Heavy
Light
None
Do you have a car? :
yes no
Do you have a digital camera :
yes no
Can you transport the dog home to veterinarian appointment? :
yes no
Are you able to attend adoption clinic days with your foster dog? :
yes no
Are you able to foster more than one dog at a time :
yes no
What can you offer this dog :
If you apply for a specific dog, what's his name :
Do you agree to a home visit BEFORE you have a dog in foster care :
yes no
Are you ready to work with the foster dog and your pets for a perfect integration :
When can you take a dog in foster care in your home :
Veterinarian’s name :
Veterinarian’s address :
Veterinarian’s phone number :
Is there anything else you would like to tell us about yourself :
Please type the text below :
