Foster Application Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Home Phone*Work PhoneEmail* Cell PhoneEmail* Enter Email Confirm Email How old are you?*What is your occupation?How many adults 21 and over live in your home? Who are they in relation to you?*How many individuals under the age of 21 live in your home? What are their ages?*Does anyone in your household have a fear of dogs?*Do you own or rent your home?*OwnRentIf you rent, have you received approval from your landlord to have an animal?*If you rent, please provide your landlord's name and contact information.*What type of home do you live in?*Single FamilyDuplexApartmentTownhouseCondoMobile HomeDescribe your home's activity level: busy/noisy, Moderate comings/going, quiet with occasional guests?*Please describe what the dog's living situation will be?*How many hours a day will he/she be home alone?*Where will the dog be kept when you are not at home? (Example: crate, pen, outside kennel, free roam in house, gated off area/room)*How will you exercise the dog?*Where will the dog sleep at night?*How will the dog be cared for during overnight absences or while on vacation?*What type of setting is your home in?*RuralSuburbanCityWhat is the size of your yard?*SmallMediumLargeIs your yard fenced?*No YardUnfenced YardYard Partially FencedYard Completely FencedWhat type of fence?*No FenceChain LinkPrivacyInvisible FenceDo you have other dogs in your home? If so, please provide the breed, gender, age, spayed/neutered, and if shots are up to date.*Have your current pets been exposed to or are tolerable of other animals?*If you have had other dogs in the past, please let us know their current whereabouts and details. (Example: I still have, died of old age/sickness, given away, hit by a car, disappeared/lost, turned in to the shelter)*Do you have any other animals in your home? If so please list.*Who will be the main caregiver?*How would you address undesirable behaviors?*What are your thoughts and views on training?*Do you have reliable transportation?*YesNoAre you willing to take the dog to training?*YesNoWill you be able to take the dog to vet appointments, monthly QCP events and allow potential adopters to visit the animal?*Will you be able to medicate an animal if necessary, even if it is only monthly heartworm or flea prevention pills?*Why are you considering this specific breed of dog or this organization?*Do you have experience with this breed? If so, please explain.*What will you do if the dog soils the floor or claws/chews the furniture?*What will you do if the dog gets into trouble by ruining something of value?*What types of behaviors do you consider Unacceptable?*In your opinion, what physical symptoms and/or behaviors would warrant immediate medical attention?*How will you discipline the dog?*What would you do if you could not keep your foster?*What circumstances, in your opinion, justify giving up your foster? (ie. barking, housebreaking, chewing, jumping up, shyness/other fears, shedding, digging, etc)*Have you ever given up a pet? If so, please explain?Please list the name and phone number for your current veterinarian. Please also give QCP permission to speak to your vet.*Please list TWO references (that are not family members) and their contact information.*Do you have a vacation scheduled within the next two months? If so, please explain.*Are you currently fostering for any other organizations? If so, please include organization name and contact information.*How did you hear about QCP?*Is there any other information that you'd like us to know about you?*I certify that the information entered on this application is true.*Enter your name and date. PhoneThis field is for validation purposes and should be left unchanged.