Intake Application Thank you for your interest in making your dog an SA R.O.C.K.S. dog! Please fill out all required fields.1 About You2 Household and Pet Info3 About Your Potential Foster Dog4 Foster ContractToday's Date* Please list name of your foster dogWhere did you find this animal?*Name* First Middle Last Date of Birth*Phone*Email Address* Driver's License Number / Issuing State*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Previous Address*If none please enter N/A Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer Information (Company Name and Phone)*Criminal history?*YesNoPlease explain.How did you hear about us?*This helps us know where to increase our marketing!Family / FriendI've adopted or fostered with you beforeWent to an eventFlyer / Print MediaFacebookTwitterInstagramPersonal Reference (unrelated to you)*Phone Number*How do you know this person?* Current residency type:*HouseDuplex4-PlexTownhome / CondoApartmentTrailer HomeOwn/Rent/Live with family or friend?*OwnRentLive with family or friendIf you DO NOT OWN, please list property owner / landlord name and phoneHousehold Members (Name / Age / Relationship to you)*Pets in Household (Name / Breed / Age)*Is your foster spayed or neutered?*YesNoIf not, why?Is your foster up to date on vaccinations?*YesNoIf not, why?Is your foster on monthly heartworm preventatives?*YesNoIf not, why?Your daily time away from home:*Home all dayOut part-timeAway 5-7 hours a dayAway 7-10 hours a dayAway 10+ hours a dayWhere do your current pets sleep?*InsideOutsideWherever they want Where does your foster dog live?*IndoorsOutdoorsBothIf outdoors, how many hours a day?Do you have a fenced yard or enclosed area?*YesNoWould you allow a home visit to ensure that your home is appropriate for fostering?*YesNoIs your foster dog:*Good with other dogsGood with catsGood with kidsWhere is your foster dog kept?*Please indicate any size, weight, or breed of your foster dog*Describe your foster dog (ex: size, temperament, breed, a dog to run with, etc.)*Why do you want to become an SA R.O.C.K.S. foster parent?*Are you willing to promote your foster dog and meet with potential adopters? (this means attending some SA R.O.C.K.S. events)*YesNo Please read through the following statements and check 'Yes' to each one to indicate you understand them and agree to comply:Do you agree to foster the intake dog until an adopter is found?* YesYour foster dog may not be accustomed to living indoors and may scratch, or chew on objects. You understand the foster home is responsible for any damage and you are comfortable working with this behavior.* YesYou will exercise caution around your personal pets and understand that S.A. R.O.C.K.S. will not be responsible for your personal pet’s medical treatment.* YesYour foster dog might take a little while to adjust to new situations, people, and animals. You understand your foster is not allowed to go to any off-leash dog parks, and you will exercise caution around your own animals.* YesYou understand your foster dog is not to be left unattended with any children.* YesYou agree to not leave your foster dog in any care other than your own, including potential fosters or adopters, unless you have received approval to do so.* YesIf the dog is adopted and returned, you agree to take the dog back and foster until a new home is found* YesYou understand your dog will be recognized as an S.A. R.O.C.K.S. dog and S.A. R.O.C.K.S. will have the final decision in regards to the adoptive home, treatment and well-being. The foster dog will only be adopted out through S.A. R.O.C.K.S.* YesAll adoption fees will be paid to S.A. R.O.C.K.S. and be considered a donation. No other fee will be charged to benefit myself upon the adoption of the intake dog.* YesYou understand S.A. R.O.C.K.S. will not reimburse you for any vet cost* YesI will be able to cover all or some of the expenses to get my foster dog medically worked up if not up to date already YesMy intake dog is up to date on vaccines and has been heart worm tested. This includes DHPP, Rabies, heartworm prevention, flea and tick prevention.*YesNoIf not, why?My intake dog has been microchipped?*YesNoIf not, why?My intake dog has been spay/neutered?*YesNoIf not, why?Please type your FIRST AND LAST NAME to be used as your electronic signature and attesting all answers above are true and correct to the best of your knowledge.****SA ROCKS recommends all fosters introduce crate training to all foster pets. A crate training document will be included in your foster packet. The transition to a new home can be stressful on a dog and may increase the chance of your pet chewing or damaging objects. ***Please Note: A 7 day notice is required for all returns, so that we may attempt to place the pet in a new foster home.