First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Cell Phone*

What is your age and birthdate?*

Do you own or rent? If you rent please name your landlord and landlords phone number.*

Are there other "critters" (birds, hamsters, reptiles etc) kept where they will be safe from a dog who might view them as "prey"? List the other critters owned by the family.*

Do the dogs seem well-socialized? Responsive to commands? How do the pers interact with each other and with family members? If you brought a dog along, how is the reaction?*

Are your present pets altered and up to date on DHLPP and Bordetella?

Veterinarian Name, Address & Phone Number. Please call your vet and give them permission to speak with us.*

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What type of fence*
Choose one: Privacy Chain Link Invisible None Split Rail

How long are you willing to foster an animal for?*

How do you feel about allowing a dog off leash when not in a fenced in area?*

How many hours a day will your dog be left alone?*

If you have answered "YES" when do you feel it is appropriate to be off leash*

Please list a neighbor as a reference that we may contact. Name, Address and Phone #*

List 2 references. Name and phone # please make sure one reference is not a family member*

By initialing below, I am indicating that I understand that by submitting this application, I am giving 2nd Chance 4 Life Rescue permission to check my criminal background, personal references and speak with my veterinarian.*