Name

Your email address

Name of dog you wish to foster

Your address

Your telephone number(s)

Do you have your own transport? Yes / No

Number of adults in household

Age(s) of adults

Occupation(s)

Hours worked

Number of children in household

Age(s) of children

Do other children visit regularly?

If yes, what are their ages?

What type of property do you live in?

Is there direct access to an outside space?

Please list your outside space, garden, patio, terrace etc

Do you own or rent the property, if renting how long is the tenancy?

If you rent, do you have the landlords permission to have a dog in their property?

Do you live on a main road, if yes is your front a garden gated?

Is your back garden fully secured? How high are the fences/hedges?

Have you previously owned dogs? Yes / No. If yes, what breed(s)?

Do you currently have a dog, if yes what age(s)/breed(s)/sex(s)?

Do you have other dogs visiting you regularly? Yes / No. If yes, please give details?

Do you have any holidays planned?

If yes, what are the plans for the dog?

What is the maximum time the dog will be alone & how often?

Where will the dog be kept when you are out for longer periods?

Name and address of your vet/proposed vet:

Do you agree to ADGAS requesting a reference from your vet? Yes / No

Any additional information you think may be relevant.

By signing this form you agree to the statement below the form By signing this form you agree to the statement below the form Yes No (please note if you sign no your application will be void)

Digitally signed (foster carer)

Digitally signed (witness)

Name and address of witness

Date