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AVGRR Foster Home Application


PERSONAL INFORMATION Date of Application ___________

Name of Applicant ______________________________________________________

Address _______________________________________________________________

City, State, Zip _________________________________________________________

Phone ________________________ e-mail _________________________________

Employer _______________________________City __________________________

Occupation _______________________ Typical # of Hours Worked ____________

Name of Co-Applicant (Adults over 18 yrs only) _____________________________

Relationship to Applicant: Spouse ___ Significant ____ Roommate____ Other ____

Employer: _______________________________ City _________________________

Occupation: ________________________Typical # of Hours Worked ____________


1. How did you hear about Autumn Valley Golden Retriever Rescue?


2. Why do you want to foster a Golden Retriever? __________________________

3. Humans in the household? Adult _________ Ages _________________

Children _________ Ages _________________

4. If there are children in the household (including visiting grandchildren), are

they experienced with pets/dog? ______________Yes ______________No

5. Who would have primary responsibility for caring for a foster dog? _________

6. Do you have any health problems, which might affect your fostering

7. Are you willing/able to adjust your schedule (if needed) while a foster dog

becomes acclimated to you home? ______ How? __________________________

8. Is there anyone home during the day? _______ Who? _____________________

If not, how long will the foster dog be left alone? __________ Where will he be

kept while alone? _______________________

9. Please describe your experience with dogs, including any formal obedience

training which you have participated.

10. Do you have any training in behavior training of modification?____________

If yes please describe? _______________________________________________

11. Do you own a large crate and are you familiar with the use of crates as it

relates to dog training? _______________________________________________

12. Describe any medical treatment you have given to dogs (i.e. shots, pills, or

other medication, etc.) _______________________________________________

13. Are you comfortable with _____bathing a dog _____ grooming a dog

_____housetraining _____clipping toenails _____giving oral or topical

medications ______shy dogs ________active dogs.

14. Have you ever had a pet/dog die at an early age, please give details ________


15. Are there any restrictions on how long you can foster a dog? ______________


16. Are you prepared to commit to fostering, knowing that a foster could possibly

stay in your household for several weeks/months? ______________________

17. When would you be able to start fostering? _____________________________


1. Do you live in a ___house ___townhouse ___apartment ____mobile home

___other ___________________________________________________________

2. Do you ______own __________rent.

3. If you rent, what is the landlord’s policy on pets/dogs? ____________________

4. Landlords Name ________________________Phone _______________________

5. Do you have a fenced yard? _________What type ______________________

Height of fence? ____________________________________________________

6. If you do not have adequate fencing (i.e. totally enclosed & secure) how will

you provide exercise for the dog? (potty exercise and physical exercise)?


7. Who will be the primary person responsible for exercising the foster dog?


8. Where will the foster dog spend its daytime? ___________________________

9. Where will the foster dog sleep at night? _______________________________

10. What dog food do you currently feed your dogs? _______________________

11. How many times per day do you feed your dogs? _______________________

12. What types of "dog supplies" do you currently have on hand? ____________


13. Do you have pets in your home now? _____Yes ______No

14. If yes, please list all pets, Sex, breed, ages, spayed/neutered

Dogs ____________________________________________________________

Cats ____________________________________________________________

Other ___________________________________________________________

15. Do your pets live ____inside ___mostly inside ____ mostly outside ___outside

16. Are your dogs house trained? _____Yes _____No.

17. List ANY behavior problems your dogs have. ___________________________



18. Have your dogs ever bitten a human? __________Yes ____________No

19. If yes, please give full details _________________________________________



20. Have your dogs ever shown aggression towards other animals?

___________Yes _____________No

21. If yes, please give full details _________________________________________



22. Are all of your dogs/pets current on all vaccinations? _____Yes _____No

23. What types of Goldens are you willing to foster? ____Males ____Females

____Adults ____Puppies ____Dogs taken in from private owners

____Dogs taken in from shelters ____Abused/Neglected dogs

____Injured/sick dogs

24. Any comments or concerns that you have concerning fostering?







Please list 2 references: Name/relationship/complete phone number:

1. ____________________________________________________________________

2. ____________________________________________________________________

Veterinarian that you use the most: Name and phone number


How long have you used this veterinarian? ________________________________

How many minutes drive from you house is this veterinarian? _______________


I acknowledge that the information contained in this form is true and correct to the best of my knowledge. I understand that any misrepresentation of fact, may result in the removal of the foster dog from my home.

Signature of Applicant __________________________________Date ____________

Signature of Co-Applicant _______________________________Date ____________

Give this application to any officer of the Autumn Valley Golden Retriever Rescue

Or mail to: Autumn Valley Golden Retriever Rescue, P.O. Box 779, Vestal, NY 13850