Foster Application Policy AgreementBefore filling out the application, please read the Fostering FAQ. The Fostering FAQ outlines details and requirements of our fostering program. Foster Home Acknowledgement I acknowledge that I am at least 21 years of age and that I have read the Fostering FAQ outlined on the Col. Potter website & agreee to the terms of the foster home agreement.Do you agree to comply all City, Country, State and Federal rules as they pertain to dog ownership?(Required) Yes No Do you agree to allow a rescue representative to visit your home by appointment to do a "safety" inspection?(Required) Yes No If you answered No, to any of the above questions, please state your reason for declining:Do you plan on using electric (hidden/underground) fencing as the primary means of containment?(Required)We do not approve foster homes for our Rescue Cairns to anyone with electric fencing as their primary means of containment. Yes No Have you had a Home Safety Inspection done at your current residence?(Required) Yes No General InformationApplicant Name(Required) First Last Applicant Age(Required)Please enter a number greater than or equal to 21.Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country We cannot accept any application from a Canadian home at this time unless the adoptive home has a clear ground transport plan to move the dog across the border by coming into the US to pick up.Do you own a second home? Yes No Second Home Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email(Required) Primary Phone(Required)Work PhoneCell PhoneIndicate the best time for a Rescue Contact to call you(Required) Previous Applications or AdoptionsHave you ever applied to adopt from CPCRN before?(Required) Yes No Are you currently approved to adopt from Col. Potter Cairn Rescue Network?(Required) Yes No Has any information on your approved application changed, since you were approved?(Required)People Living in Home | Current/Past Pets | Home Information | Plans to Care for the Dog | 4 Personal References | Vet Reference(s) Yes No Did you adopt a dog previously from CPCRN?(Required) Yes No What was the Col. Potter dog's name you adopted?(Required) What year did you adopt a dog?(Required) Household InformationDoes everyone in the household know that you are applying to be a foster home and do they all agree?(Required) Yes No Please Explain(Required)List of ADULT FAMILY members currently residing in the household, INCLUDING YOURSELF(Required)Click on the + sign to add additional rowsNameAgeOccupation Add RemoveDo any ADULT NON-FAMILY members currently reside in the household?(Required) Yes No List of ADULT NON-FAMILY members currently residing in the household(Required)Click on the + sign to add additional rowsNameAgeRelationship Add RemoveDo any children under 18 years of age reside in the household?(Required) Yes No List of CHILDREN UNDER THE AGE OF 18 residing in the home(Required)Click on the + sign to add additional rowsNameAgeRelationship Add RemoveDo any children under 18 years of age VISIT FREQUENTLY?(Required) Yes No Please list any children under 18 years of age who VISIT FREQUENTLY(Required)Click on the + sign to add additional rowsNameAgeRelationshipFrequencyTypical Duration Add RemoveDo any members of your household have allergies?(Required) Yes No List the members and describe the reaction to animals(Required)Current PetsDo you currently have any pets in your home?(Required) Yes No What heartworm preventative do you use? If none, please indicate why not(Required)List all CURRENT pets(Required)Click on the + sign to add additional rows for each petNameSpeciesAgeGenderSpayed/Neutered?TemperamentCurrent Health Add RemovePlease tell us about your existing pets(Required)Playfulness, sociability, any other significant thing you can think of…this will help find the right new family member for you.How long has it been since you've had a pet in your home other than to visit?(Required) Previous PetsHave you ever previously owned a dog?(Required) Yes No How many dogs have you owned in the past 15 years?(Required)Have you ever previously owned a RESCUE dog?(Required) Yes No When did you own a Rescue Dog?(Required) Describe in detail the pets that are no longer with you for any reason, and tell us why(Required)Home InformationIn what type of home do you live?(Required) Single Family Townhome Condominium Apartment Cabin Motorhome Boat What type of structure is the home?(Required) Single Story Bi-Level 2-Story Other Do you live on the ground floor or an upper level?(Required) Ground Floor Upper Level Do you have stairs leading to or inside your home and how many are there?(Required)Do you rent or own your own? Own Rent Does your landlord allow pets? Yes No Landlord's Name(Required) First Last Landlord's Address(Required) 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 Landlord's Phone(Required)Do you live in a community governed by an HOA?(Required) Yes No If you do live in a community governed by an HOA, what re the requirements for pet ownership?(Required) How would you describe the area in which you reside?(Required) Urban Suburban Semi-Rural Rural Do you have a yard?(Required) Yes No Is the yard fenced in?(Required)Traditional fence, not electric Yes No Describe the materials & height of fence, and size of yard(Required)Do you have electric (hidden/underground) fencing or plan to install it?(Required) Yes No How do you plan to keep your dog from roaming off of your property?(Required)Do you agree that Terriers should NEVER be left off-leash or outside unless securely fenced in(Required) Yes No Plans to care for a dogWhere will the dog be kept during the day?(Required) Indoors Outdoors Both Indoor Location(Required) Loose Crated Basement Other Outdoor Location(Required) Loose Fenced Yard Tied Up Kennel Run Garage Other Who will be responsible for feeding, housebreaking/training?(Required) Myself My Spouse My Child Other Will anyone be home during the day?(Required) Yes No Who will be home & what will their responsibilities be?(Required)Describe the exercise schedule you will have for the dog(Required)How many hours a day will the dog be left INSIDE unattended?(Required) Less than 1 hour 1-2 hours 3-4 hours 5-6 hours 7-9 hours More than 9 hours How many hours a day will the dog be left OUTSIDE unattended?(Required) Less than 1 hour 1-2 hours 3-4 hours 5-6 hours 7-9 hours More than 9 hours Never When you are away on trips, where will the dog be kept?(Required) Home, someone comes over to feed Pet sitting service Board at dog kennel Other After the dog has been adequately house-trained, where will it sleep at night?(Required) What do you intend to feed the dog?(Required)PreferencesWhat gender dog do you prefer?(Required) Male Female No Preference Would you consider a dog of the opposite gender?(Required) Yes No What age range are you willing to consider for fostering? Check all that apply.(Required) Puppy Youngster (1-3) Teenager (4-7) Mature (8-10) Senior (11+) Would you consider a special needs dog?(Required)Special Needs dogs could be of any age. They could be a dog with a vision or hearing loss, or have some other medical condition. They could be dogs in their twilight years who need a loving foster home. Yes No Are you willing to foster a dog from any part of the country?(Required) Yes No What is your one-way driving mileage limit?(Required) List any other details about you/your family that will help us match a foster dog.(Required)ReferencesFOUR PERSONAL REFERENCES ARE REQUIRED in addition to your current veterinarian. Only one of these references may be a family member. All references must be 21 years of age or older. NOTE: If you do not provide 4 personal references, your application will be rejected.Personal Reference 1Name(Required) First Last Relationship(Required) Address(Required) 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 Phone(Required)Best Time to Contact(Required) Personal Reference 2Name(Required) First Last Relationship(Required) Address(Required) 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 Phone(Required)Best Time to Contact(Required) Personal Reference 3Name(Required) First Last Relationship(Required) Address(Required) 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 Phone(Required)Best Time to Contact(Required) Personal Reference 4Name(Required) First Last Relationship(Required) Address(Required) 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 Phone(Required)Best Time to Contact(Required) Vet Reference 1Vet Type(Required) Current Vet Previous Vet Not Used Yet List how long you've used this vet and the names of the animals treated(Required)List how long ago you used this vet and the names of the animals treated(Required)Name of Practice(Required) Name of Doctor(Required) First Last Address(Required) 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(Required)Vet Reference 2Vet Type (Reference 2) Current Vet Previous Vet Not Used Yet List how long you've used this vet and the names of the animals treatedList how long ago you used this vet and the names of the animals treatedPractice Name Doctor Name First Last 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 PhoneAcknowledgement & ConsentConsent(Required)By submitting this application, you give us your permission to call all of your listed references, including your Veterinarian(s), to determine responsible pet ownership. If you have included a work telephone number for any of your references, you are stating that they may receive telephone calls at their place of employment.You must aprovide proof of being of legal age in your state; Photographic identification with your current address may be required prior to fostering.I represent that the information that I have provided on this form is the truth to the best of my knowledge and belief. I/we hereby give my/our permission to CPCRN to use any of the above information to confirm that this foster application is deemed to be correct. I hereby certify that I have not been convicted or otherwise been found guilty by any governmental authority of animal cruelty, neglect or abandonment, or of failing to provide adequate shelter to an animal.I understand that CPCRN may, at its sole discretion, determine that a Cairn rescue will not be approved for fostering by me or my family. I acknowledge that I have read, understand, and agree to these policies and proceduresCAPTCHANameThis field is for validation purposes and should be left unchanged.
