Spam filter - type chihuahua here:
First Name:
Last Name:
Email Address:
Street:
City:
State:
AL
AK
AZ
AR
CA
CAN
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code:
Home Phone:
Work Phone:
Age:
Current Employer (Organization name and address):
I have read What is CRT and understand the contents
No
Yes
I have read the Policies and Procedures document and understand the contents.
No
Yes
Have you volunteered with a breed rescue group previously?
No
Yes
Have you fostered previously?
No
Yes
Children in household?
No
Yes
Number of children and ages:
Long range plans within the next year?
Residence
Apt/Condo
Townhouse
Trailer
Single family dwelling
Farm
Other
Own or Rent
Own
Rent
If renting, please provide landlord's name, address and telephone #:
Fence
No Fence
Wooden Fence
Chain Fence
Size of living area:
Size of fenced area:
If there is not a fenced yard, will you provide leashed walks:
Frequently
Occasionally
None
Please list the names of all non-related residents/Housemates:
Are you willing to permit a home check by a CRT representative?
No
Yes
How many hours will the foster(s) be left alone per day?
Where will the dog be kept when alone during day?
Where will the dog be kept when alone during night?
Where will the dog be kept when alone when family is home?
If there is any aspect of your home that a dog could affect (white carpet, antiques, etc.), please identify:
What is the level of activity in your household?
Laid back
Constantly on the run
Athletic/Jogger type
Physically handicapped
Does anyone in your household have allergies to hair or dust?
No
Yes
Are you often away for extended periods?
No
Yes
If so, will you:
Board
Hire a pet sitter
take the animal with you
Do you currently own any dogs?
No
Yes
If so, please provide breed(s), sex(es), and age(s)
Do you currently own any cats?
No
Yes
If so, please provide sex(es), and age(s):
Do you own any other type of pets?
No
Yes
If so, what kind?
Are all your current pets up to date on vaccines? (If you don't have any pets, answer for past pets.)
No
Yes
Are all current pets and were all past pets spayed or neutered? (If you don't have any pets, answer for past pets.)
No
Yes
Not applicable
Have you owned animals not listed above in the past?
No
Yes
If yes, their disposition was:
Ran away
Stolen
Sold
Lost
Given away
Given up for adoption to Rescue Organization
Given up to Animal Shelter
Euthanized
Died
Do you have a gender preference?
Either
Male
Female
Any special circumstances CRT should be aware of?
No
Yes
If so, please describe:
Are you willing to groom the animal?
No
Yes
Are you willing to foster an animal that has health problems?
No
Yes
If yes, any problem not accepted?
What age are you willing to foster?
Any Age
adult
Puppy
Senior
Are you willing to provide basic training and socialization?
No
Yes
If you have any children in the household, how much of the responsibility will your child be given in the care and management of the dog?
Maximum
Some
Minimal
None
How much adult supervision will the dog and child be provided?
Maximum
Some
Minimal
None
How many interactions will the dog have with neighborhood children?
Maximum
Some
Minimal
None
How would you encourage or reinforce the foster dog's appropriate (*good*) behavior?
How would you prevent or manage the foster dog's inappropriate (*not so good*) ill-timed behavior?
Are all members of your household aware that you will be fostering?
No
Yes
Do they all approve?
No
Yes
Are you prepared to keep the foster dog for an indefinite period of time, until the dog can be placed into an approved home?
No
Yes
Are you aware that you must notify the CRT Board of any routine medical care necessary for the dog BEFORE the medical care is performed?
No
Yes
Are you aware that your application must be approved before you are enlisted as a CRT volunteer?
No
Yes
Do you know another CRT volunteer whom we can contact for a reference? If not just put N/A. If so, please list their name and contact information below:
Do you work with any other rescue groups who we can contact for a reference? If so, please list group(s) and contact information below
Please provide the name, address and phone number of the veterinarian for your pets.
Please provide name, address and phone number for your first personal reference who is not a relative.
Please provide name, address and phone number for your second personal reference who is not a relative.
** Please notify your veterinarian and personal references, informing them that someone from Chihuahua Rescue & Transport will be contacting them. The quicker we can get in touch with them, the quicker your application can be processed.**