Transport Dog Application Transport Dog Application Animal Name-First ChoiceAnimal Name-Second ChoiceAnimal Name-Third ChoiceApplicant's Full Name*Are you over 18 years of age?* Yes No Email address* Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Physical Address (if different from above) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Alternate Phone NumberEmail Have you fostered for HSWA before?* Yes No Reason for fostering I want to potentially adopt I want to help the shelter Do you:* Rent Own If you rent, do you have permission from your landlord to have a pet? Yes No Landlord’s Full NameLandlord’s Telephone NumberDoes anyone in your household have pet allergies? Yes No Average number of hours per day the pet will be alone?Where will they be kept?Do you have any other pets? Yes No How many and what kind?Are your pets spayed/neutered? Yes No If no, why not?Are all of your pets up to date on rabies and distemper vaccinations? Yes No Is your dog(s) vaccinated against bordetella (kennel cough)? Yes No If there are dogs in your home, please upload a copy of the most current vaccination records (for each dog) Drop files here or Select files Accepted file types: jpg, gif, pdf, png, Max. file size: 1 GB. Name of veterinarian:Please list the names and ages of all people in the household:Please list the names and phone numbers of at least 2 non-family member references:*Please keep my application on file for future transports. Yes No Animal Availability Agreement*I understand that completing and submitting this application does not guarantee the availability of an animal for foster, nor does it guarantee that my application will be approved. HSWA is unable to “hold” animals. I agreeDate: Month Day Year Email Δ
