Lighthouse Boxer Rescue...lighting their way home
Friday, 31 Dec 2010
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Applicant References Home & Family Pets Volunteer Info
PRIMARY APPLICANT
** First Name:    Last Name:
 

E-mail address:
**

Home Phone: 

  DaysEvenings
** Address
**   City 
** State    Zip   County 
 
**

Occupation:
  Employer:
CO-APPLICANT
  First Name    Last Name
  E-mail address:
  Occupation:
  Employer:
** Required field
Applicant References Home & Family Pets Volunteer Info
PERSONAL REFERENCE
Note: This must be a non-family member and cannot be someone living in your household.
**

Name:
 

E-mail address:
**

Home Phone: 
** Yrs Acquainted
CURRENT VET (if applicable)
  Vet Name:
  Clinic Name
 (if applicable):
  City, State
  Phone
PREVIOUS VET (if applicable)
  Vet Name:
  Clinic Name
 (if applicable):
  City, State
  Phone
** Required field
Applicant References Home & Family Pets Volunteer Info
HOME TYPE
** Home type:
** Own/rent:  Own Rent
  RENTERS
Are pets allowed? Yes No
Pet limitations:
Landlord Name:
Landlord Phone:
  Previous Address:
FENCING/CONTAINMENT
** Fenced yard?  Yes No 
  Fence type:
  Fence height:
  Fenced area dimensions:
** Kennel run? Yes No
  Describe kennel: 
  If no fence or kennel, how will exercise and toilet be handled?
HOUSEHOLD INFO
**
# of adults:      Age(s) of adults:  
**
# of children in home:    Age(s) of children:
** Are there any family members who need special consideration for any reason? Yes No  

  • If yes, please explain:
** Required field
Applicant References Home & Family Pets Volunteer Info
CURRENT PETS
Pet # Name Type Breed (if dog) Sex Age Spay/Neuter? Last vet visit date Last HW test date On HW prevent?
1

2

3
4
5
6

Comments:

Applicant References Home & Family Pets Volunteer Info
VOLUNTEER INFORMATION
** What type of help are you interested in providing?
Foster Home
Application Processor
Fundraising
Other  
** Have you ever fostered a dog for any type of humane organization or rescue group before?   Yes No
  If yes, for whom and what breeds?

Have you ever owned a Boxer before? Yes No
Are you willing to foster an older dog? Yes No
Are you willing to foster a dog requiring special care? Yes No
Can you foster:
Short term only
Long term
Doesn't matter
How many hours (approximately) will any dog be left per day?
Do you have a crate available? Yes No
** Tell us any information about yourself, your family or your other animals that you think would be helpful in our decision to allow you to foster for our rescue group:
 
** What is your main goal by becoming a member of our rescue group?
 

  Do you have any other special skills (public speaking, writing, records keeping, etc.) that you would like to volunteer?
 
  How did you hear about us?
 
** Required field
AGREEMENT
  • I agree that typing my name here is the same as signing my name to this legal document.
  • I give Lighthouse Boxer Rescue my permission to contact any and all references listed on this application.
  • I understand that if the information contained herein is in any way found to be false, my application will be denied.
Signature: