Name ____________________________________________________________
Address _________________________________________________________ ___________________________________________________

E-mail ________________________________
Phones: Home ________________ Work __________________
Number of family members: _________
Ages of children ____________

Who will be the primary care giver?_________________________
How many family members are home during the day? _____
If no one, who will care for the Foster dog? ______________________
Where will the dog sleep? ___________________________________________
Do you own or rent? __________
How many years at current address? __________
Is your yard fenced? _________
Explain why you and your family are looking to foster _________________________________________________________________________

___________________________________________________________________________

__________________________________________________________________________________
Who will be responsible for training the dog? ________________________
Have you owned a Yorkshire Terrier before? ____________________________
How many other pets do you have now? ____ What kind are they, and how old? ____________________________________

Have you ever returned a dog, if yes why?________________________________________________

Have you ever given a dog away or surrender it to a Shelter?________________________________________
Estimate the cost to feed and care for your Yorkie you expect for one year?______________________

If your Yorkie had an accident and the veterinarian told you it needed an operation that would cost $1200, what would you do? _____________________________
Who is your current veterinarian (or one you will use), include phone number _________ _____________
Have you used a crate to house train before? ______
How many hours a week do you plan to spend with your dog? ________
Are you planning to move in the next 5 years? ______
What will you do with your dog when you go on vacation? __________________
Are you prepared to make this commitment for the next 14 years? _________
 Are you interested in a male _______or female_______ Foster Dog?

Do you understand that if you no longer can keep the Foster Dog that it must be
returned to us and NEVER go to rescue, a shelter, be used in animal testing,
go to a puppy mill or to an unscrupulous breeder?  That the dog belongs to the Breeder uniquely up until the time the Breeder decides that the dog shall be retired?________________________________

Below, please add any additional information about yourself and your family that you feel is pertinent and help us in the decision in considering your family for one of our future Foster Dogs:

________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

_______________________________________________________________________________________

Please provide 3 names with their phone number that we can contact for references (at least 1 that is not directly related to you):

1. ___________________________________________________

2.____________________________________________________

3.____________________________________________________

Thank-you for taking the time to fill out our questionnaire and sending it to us. We will notify you of it's reception.

E-mail to: gazou009@rogers.com

Shan's Yorkie Haven