Become a Chihuahua Foster Care Partner

First Name: Last Name:
Address:    
City:    
State: Zip:
Home Phone: Cell Phone:
Email:    
Preferred Contact Method: Phone Cell Email Best Time to Reach: Day Evening
Employer: Occupation:
Number of Adults in Household: Hours Worked Per Week:
Number of Children Ages of Children:
Are all of the adults in the household aware that you are fostering a dog/puppy? Yes No Who will have primary responsibility and state the age:
Does anyone in the household have pet allergies or asthma? Yes No Have you owned
or cared for a Chihuahua before?		 Yes No
Kind of fostering you can provide, check all that apply: Nursing pups no Mom Mom with litter Chi with medical issues
Chi with behavior issues Healthy any age Senior Chi
2 or more together Any condition
Residence type: Single Family Townhouse Condo Apartment Other
If rent, does your lease allow animals? Yes No If yes, are there
any Chihauhua restrictions?		 Yes No
Management company or landlord name:
Landlord phone:
Fenced yard? Yes No Fence type?
If no fence, method
of restraint used?		 Will your foster
be an inside dog?		 Yes No
Will the foster be allowed outside unattended? Yes No Will the foster ride in the back of a pick-up? Yes No
How may hours a day will the dog or puppy be left alone? If confined in a room, which room?
If crated, which room? How often and what kind of exercise will you give your foster?
Are there times when your foster will be tied outside? Yes No    
Do you travel or
relocate frequently?		 Yes No If yes, please explain:
Please list all animals
you currently have:		 Please list name, species, age, M/F, Spayed/Neutered, if vaccinations up to date:
Please list the animals you've had as an adult: What heartworm preventative have you given your dogs?
What flea and tick treatment have you given your dogs?    
Have you ever given away, sold or surrendered an animal? Yes No If yes, what were the circumstances and to whom?
Some animals are either not housetrained, or, when introduced to new surroundings, stressed or as an attention getter, will have housetraining issues. Are you prepared for this? Yes No What method of training/discipline
do you use?
Do you know how dogs
get heartworm disease?		 Yes No How long do you think it takes to housetrain a puppy?
Are you willing to allow a representative to contact your personal veterinarian? Yes No Veterinarian name and phone number:
List any surrounding cities you can travel to for picking up a Chihuahua.
Your Service Area		 Any comments you would like to make:
I certify the information I provided is true. I understand that any false information will result in nullification of all adoptions and forfeiture of any dogs in my possession.

Yes    Print Full Name
 I also certify that neither I, nor anyone living in my household, has ever been investigated for or charged
with animal cruelty, neglect, or abandonment.

Yes    Print Full Name