Foster Intake – REFURBISHED PETS OF SOUTHERN MICHIGAN

Foster Parent (First Name Only)*

First Name only in this field. The PDF can not be edited after submission. If you include your last name you will have to resubmit.

Date

MM slash DD slash YYYY

Foster Dogs Name*

Enter the dogs name

Male or Female

Male

Female

Foster Dogs Age

Enter the dogs age in Years and/or Months

Years*

Months*

How long with Foster

Foster Dog's Breed (best guess)*

Best Guess on dogs breed is completely acceptable on this form.

Dogs weight, (Estimate is fine if you don't know)*

Only enter numbers no # sign

Known Health Issues/Additional Background Information

If your dog has had intestinal issues, Has a limp or any medical treatments its best to list them here.

Temperament

Children*

Good

Bad

Additional Information

Dogs*

Good

Bad

Additional Information

Cats*

Good

Bad

Additional Information

Date that Heart worm, Flea and Tic medicine is due.*

MM slash DD slash YYYY

If flea medicine was given on a different date than the Heart worm medicine that is OK. We do not Administer flea med's in the prison program.

Did the dog show any of the following?

Guarding

Barking

Potty Issues

Fear

Jumping

Howling

Reactivity

Digging

Separation Anxiety

Chewing

Biting

Mouthing

Pulling on lead

Aggression

Impulse Control

If yes to any of the above, please give a brief description below:

If dog played with other dogs while in your care, please answer the following:

How many Dogs?

Size?

Years

Months

Breed

Size?

Years

Months

Breed

Size?

Years

Months

Breed

During play, were they:

Vocal

Easily Overwhelmed

Aggressive

Herding

Submissive

Mutual Play

Other

Fence Requirements, Riding in cars

Fence Required?*

Standard Only

6 foot Privacy Fence

Wire less fence

No fence requirement

Issues

Please check the type of fence your foster requires. If you click issues it will open up a box to explain why the dog needs what it needs.

Additional Information about the fence requirement

List here if there are any issues the handlers or the rest of the group should be aware of.

Does Dog travel well in the car*

Yes

Issues

Please explain any issues with Riding in a vehicle

Dietary Needs, Amount of food the dog is needing, any supplements required.

Current Dog Food your Foster is Eating*

Brand and Flavor if you still have the bag.

How many times a day is the Dog eating? How much per feeding?*

example 1 cup 2xs a day

Any Special Dietary Needs

Please fill this in if you foster needs a special food, fish oil pills, hip/joint chews

Known Commands and Additional Information Required

List Known Commands Here

If your dog knows sit, wait, etc.

Additional Information*

List everything you know about your Foster dog here. This part of the form is very important to the handlers, the more info you share the more they can prepare for the dog ahead of time.

Photo of your Foster Dog*

Photo of your Foster Dog

Foster Intake Form

Foster Dogs Age

Temperament

If dog played with other dogs while in your care, please answer the following:

Fence Requirements, Riding in cars

Dietary Needs, Amount of food the dog is needing, any supplements required.

Known Commands and Additional Information Required