Name :
Street adress :
City :
Province :
Postal code :
Home phone :
Email (this is necessary as this is how we initially contact you) :
Occupation :
Work phone :
Reference #1 (include full name, email and phone) :
Number of years acquainted with reference #1 :
Reference #2 (include full name, email and phone) :
Number of years acquainted with reference #2 :
Do you live in :
condo
house in the city
house in the country
house in the suburbs
rented appartment
If renting, are you allowed to keep dogs? :
yes no
Do you have a fenced yard? :
yes no
If not, how will exercise and bathroom needs be handled? :
How many adults in your household? :
How many children in your household and what are their ages? :
Do you own dogs currently? :
yes no
Dog #1: please list breed, age and sex :
Is this dog spayed/neutered? :
yes no
If not, why not? :
Indicate date of last vaccinations and rabies shot :
Indicate date of last heartworm test :
Dog #2: please list breed, age and sex :
Is this dog spayed/neutered? :
yes no
If not, why not? :
Indicate last date of vaccinations and rabies shots :
Indicate last date of heartworm test :
Dog #3: please list breed, age and sex :
Is this dog spayed/neutered? :
yes no
If not, why not? :
Indicate last date of vaccinations and rabies shot :
Indicate last date of heartworm test :
Do you own cats or other small pets? Please list your other pets. :
Are they spayed/neutered? :
If not, why not? :
What is the name of your current veterinarian and veterinary clinic? :
Phone number of veterinarian :
Have you owned any other dogs in the past who are no longer with you? :
yes no
What happened to them? :
Have you owned a Boxer before? :
yes no
Where will the foster Boxer spend his day? :
Where will he sleep at night? :
How many hours will he be left alone daily? :
Have you ever fostered for another organization before? If so, which one? :
Are you willing to foster :
adult
foster dog requiring special care
puppy
senior
Can you foster :
doesn't matter how long
long term
short term
somewhere in the middle
Do you have a crate available? :
yes no
Please tell us anything else about yourself or your family that you think would be helpful to us :
Please tell us about your reasons for wanting to foster a Boxer with Boxer Rescue Quebec :
If you have any special skills that you would like to volunteer in addition, please list them :
Do you agree to a BRQ rescue agent visiting your home prior to approval? :
yes no
Please type the text below :
