Transport Dog Application

Animal Name-First Choice

Animal Name-Second Choice

Animal Name-Third Choice

Applicant's Full Name*

Are you over 18 years of age?*

Yes
No

Email address*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Physical Address (if different from above)

Street Address Address Line 2 City State ZIP Code

Phone Number*

Alternate Phone Number

Email

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 Name

Landlord’s Telephone Number

Does 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

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 agree

Date:

MM

DD

YYYY

CAPTCHA

Email

Transport Dog Application

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