| Date |
|
| First Name |
|
| Last Name |
|
| Street |
|
| City |
|
| State |
|
| Zip
Code |
|
| Phone Home |
|
| Phone Work |
|
| Phone Cellular |
|
| Email |
|
| I
am applying to: |
|
| Which states can you cover? |
|
| List special skills and areas of interest: |
|
| Do
you presently own pets? |
|
| If
yes, list the name and kind for each pet (e.g. Waldo — dog;
Fluffy — Cat; Petie — Parrot): |
|
| If
you own dogs, are they all Spayed/Neutered? |
 |
| If
your current dogs are not altered, please explain why not |
|
| Are
they up to date with Rabies? |
|
| Are
they regularly tested for heartworm? |
|
| Are
they on monthly heartworm prevention? |
|
| Are
there children presently living in your home? |
|
| Kids Ages |
|
| Do
you rent or own |
|
| Type Home |
|
| If
you rent, do you have permission from your landlord to keep a
dog? |
|
| Landlord Name |
|
| Landlord Phone Number |
|
| Fence |
|
| Fence Type |
|
| Fence Height |
|
| Have you ever fostered a dog before? |
|
| How
many hours will the dog be alone during the day? |
|
| Where will you keep the dog while you are at work or
out on errands |
|
| Do
you have a crate to keep the dog in? |
|
| Is
there a limit to the length of time you can keep the dog until
it gets adopted? |
|
| If
yes, how long can you keep the dog? |
|
| Why
is there a limit? |
|
| Are
you willing to assume financial responsibility for the every
day care of the dog? |
|
| Do
you understand that all placements must be done through the
AMPS application process? |
|
| Do
you understand that any min pin you foster as an AMPS
volunteer is the sole property of AMPS and must be returned to
AMPS if requested to do so? |
|
| Are
you willing/able to do home checks and post adoption checks
for dogs in your area? |
|
| Are
you willing/able to provide telephone support on training and
behavioral issues? |
|
| All
paperwork for placement in homes (e.g. applications,
contracts) must be forwarded to the AMPS Directors within five
business days of completion. Are you able to ensure that this
requirement is met? |
|
| Would you able to take a dog to a vet for treatment,
spay/neuter, Microchipping, etc. (at the expense of AMPS)? |
|
| Would you be able to meet with an interested person
at a dog’s location (e.g. owner’s home)? |
|
| Would you be able to have an interested person meet
a dog at your home? |
|
| Please provide us with a veterinary reference
(including phone number). Note: Due to the new federal laws
regarding the privacy act, you will need to contact your vet
immediately and give permission for AMPS to contact them
regarding your pet’s records. |
|
| Please list a personal reference (Required
information is Name, address, phone number, relation to
you). |
|
| Any
other coments you like to share with us |
|
|
The dog shall reside at the foster
family’s address and may not be given to anyone else or placed
in any other home or facility. If the dog cannot be kept by
the foster family, said family shall notify the Regional
Coordinator or Directors of AMPS immediately. The dog may not
be sold, abandoned, relinquished to a pound or shelter or
another rescue group, transferred or given to any other
person, persons, group, organization or institution. By
submitting this application, you attest that you have read the
above disclaimer and agree to the terms therein.
You must be at least 21
years old to submit this application. |
|
|
| - Required field |
|
|