Foster Home Contract Information for New Owner Rescue Worker InformationPulls from logged in, user’s profileName 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 Email Phone(Required)Foster Dog InformationDog's Name(Required) CPCRN Tag ID(Required) Dog's Breed(Required) Cairn Terrier Westhighland White Terrier Scottish Terrier Norfolk Terrier Norwich Terrier Australian Terrier Border Terrier Min. Schnauzer Mixed Breed Dog's Gender(Required) Male Female Dog's Age(Required) Dog's Weight(Required) Color of the Dog(Required) We cannot stress how important all the New Owner Contact Information is. We have had many dogs get loose on day 1 and this is the primary location for Tags information for the owner at that time. Multiple phone numbers and email addys can be put in the below blocks. CPCRN Contract Team rely on the information you provide here for the contract, be very specific and detailed. WHAT YOU FILL IN ON THIS FORM WILL BE PUT ON THE LEGALLY BINDING CONTRACT!! BE EXACT AND DETAILED!!!Anticipated Adoption Date(Required) MM slash DD slash YYYY Adoptive Owner Name:(Required) Adoptive Co-Owner Name: Adoptive Owner 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 (Do not use mailing address or PO Box for the contract) Primary Adoptive Owner Contact Information* Home Phone(Required)Cell PhoneWork PhoneEmail(Required) MatchMaker Name: Additional Dog InformationDoes the dog have a microchip?(Required) Yes No Unknown Company Name Microchip Number Confirmation of Spay/Neuter (Mandatory Procedure): Confirmed, Date Unknown Confirmed, Date Known Neutered Date MM slash DD slash YYYY Inoculations | Testing | Dental CareInoculations Type 1 Year 2 year 3 year Rabies Vaccine Date:(Required) MM slash DD slash YYYY Next Due Date:(Required) MM slash DD slash YYYY Core Vaccine or Booster Date:(Required) MM slash DD slash YYYY Next Due Date:(Required) MM slash DD slash YYYY Type: Exactly as written on vet records (i.e. DHLPP, DA2PP, DHLPP-C, DA2PPV, etc.) Heartworm Test Date:(Required) MM slash DD slash YYYY Heartworm Results Positive Negative Internal Parasites Test:(Required) MM slash DD slash YYYY Internal Parasite Results Positive Negative Wormer Type Wormer Date MM slash DD slash YYYY Please select any additional vaccines/treatments that have been administered: Bordetella/Kennel Cough Lepto (if not included in Core, Rattlesnake, Canine Flu, etc.)oice Lyme Teeth Cleaning Dental Procedure and Extractions Internal Parasites Test Other Bordetella/Kennel Cough Vaccine Date MM slash DD slash YYYY Bordetella/Kennel Cough Next Due Date MM slash DD slash YYYY Bordetella/Kennel Cough Vaccine Type Vaccine Nasal Oral Lepto Date MM slash DD slash YYYY Lyme Vaccine Date MM slash DD slash YYYY Teeth Cleaning Date MM slash DD slash YYYY Dental Procedure & Extractions MM slash DD slash YYYY Dental Procedure & Extrations DetailsMedicationHeartworm Preventative Status(Required) Heartworm Preventative administered Heartworm in not prevalant in my area, so not administered Heartworm Type How Often Administered Monthly Every Six Weeks Other Notes Heartworm Preventative Date Last Given(Required) MM slash DD slash YYYY Heartworm Preventative Next Date Due:(Required) MM slash DD slash YYYY Flea Preventative (if applicable) Type: How Often Administered Monthly Other Notes Flea Prevention Date Last Given: MM slash DD slash YYYY Flea Prevention Next Date Due: MM slash DD slash YYYY NOTE:Flea preventative is very costly to CPCRN. We don’t recommend you send any along with your foster but if you need to please let us know how many doses and the cost PER DOSE (check with your mentor for the current cost). How many doses are you sending to the new owner with the dog? Total Cost @ $5 Per Dose:Other Medications (describe dosage, frequency, type, reason for use, etc.)BE SPECIFIC CPCRN wants everything detailed on the contract the new owner will sign for legal issues. BE SURE TO INDICATE TOTAL COST OF EACH MEDICATION FOR THE CONTRACT!PLEASE LIST THINGS WHICH SHOULD BE IN THE "TERMS OF ADOPTION" PAGE OF THE CONTRACT: (Such as "is a digger, be careful" or "Must be fed separately from other dogs" or "Needs obedience training," "Crawls under fences," "Very shy and timid," "Doesn't like riding in cars", "Is food aggressive", "Not completely housebroken", "Frightened of thunderstorms", etc).THIS IS A VERY IMPORTANT PART OF OUR ADOPTION CONTRACT. PLEASE BE SPECIFIC HERE ABOUT THING TO BE DOCUMENTED ON THE CONTRACT FOR LEGAL REASONS:CrateIs the new owner providing their OWN crate for the dog's transport?(Required) Yes No Where did you get the crate/cage or carryon bag in which the dog will be transported? I purchased it and I will submit a bill for reimbursement I purchased it and I will be donating it to CPCRN CPCRN sent it to me It came with the dog Other (be specific) Reimbursement Amount Specific details on how crate was obtainedWhat type of crate is it? Plastic “Vari-Kennel” type Wire cage Soft-sided airline carryon bag Approximate size: Condition: Brand new/never used Excellent – Only used for this dog OK – Not new but still in good condition Fair or Poor – Old or badly worn List all crates which were supplied by CPCRN that remain in your possession after this adoption takes place by type (use wording from list above), condition (use wording from list above), and approximate size (dimensions or Veri-Kennel size number). List EACH crate separately. If the crate is in use for fostering a specific dog, so note. If no CPCRN crates remain in your possession, enter “NONE”:TravelHow is the dog being transported to its new owner? New owner is driving entire way to my home I’m driving the entire way to new owner I’m meeting new owner part-way New owner is picking up dog and flying it back in cabin of plane I’m shipping dog to new owner as “live cargo” via commercial airline Either a CP volunteer or I will fly dog to new owner in cabin of plane Transporting via CP “Transport Team” (Must be approved!) Sending via overland commercial pet transport service Other (details please): Explain other travel arrangementsAre you, CPCRN, or any of our volunteers, traveling ANY portion of the trip to deliver the dog to its new Owner? Yes No Please note that the new owners are expecting they will have to pay for this mileage, we must maintain consistency. Yes No If YES, how many total miles ONE WAY?Indicate any additional fees (such as highway tolls, airport tolls, parking, etc.) Health CertificateIf the dog is being flown by commercial airline OR being shipped via commercial overland pet transport, what is the ENTIRE cost of the required Health Certificate?Be certain to include the cost of the office exam AND the Health Certificate. Please call your vet to receive a quote before proceeding.Airline FareIs the owner paying the fare directly? Yes No Training & BehaviorDoes the dog use a "doggy door" to go outside to potty?(Required) Yes No Partially (provide details) Partially housetrained detailsIs the dog housetrained?(Required) Yes No Partially (provide details) Does the dog understand a "human door" to go outside to potty?(Required) Yes No Is the dog leash trained?(Required) Yes No Is the dog crate trained?(Required) Yes No Is the dog crated trained so that he/she will sleep quietly in his crate at night as required?(Required) Yes No Where does the dog SLEEP at night? *(Required) In his/her crate or cage Confined to a specific room or area of the house, but NOT in a crate or cage (i.e. baby gated,) Loose in the house (anywhere it chooses to sleep) In bed with us or another family member Where is the dog fed? *(Required) In his/her crate or cage Confined to a specific room or area of the house – away from other dogs Other (please be specific about where the dog is fed): Other feeding place Is the dog comfortable riding in the car?(Required) Yes No If No, explain:Is the dog well behaved around children?(Required) Yes No Unknown If No, explain:Does the dog tolerate other dogs? *(Required) Yes No Unknown If No, explain:Does the dog tolerate cats? *(Required) Yes No Unknown If No, explain:Items You Are Sending Along With The DogPlease provide a checklist of ALL items you are sending to the new owner: Toys CP Blanket Food Medication Leash Collar with CP ID Tag Attached Harness CPCRN Bandana Other Items Food Amount(Required) Food Brand(Required) Name(Required) Dosage(Required) Frequency(Required) Leash Type(Required) Other ItemsGroomingPlease let us know IF the following procedures will be done shortly before the Cairn is adopted Bathed and/or Groomed Brushed Nails Trimmed PLEASE NOTE:Because first impressions are so very important to owners and their new furbutts, please assure that the dog is clean and fresh smelling when he or she meets his new owner. Please have his or her nails trimmed, his coat trimmed or groomed if possible, and assure that there are no mats in his coat. If you are sending a crate with the dog, please ensure that it is extremely clean (newly washed just prior to adoption) and that any toys, bedding, collars, leashes, etc., have been thoroughly cleaned. IF bathing or grooming the dog, cutting its nails, or washing/cleaning its crate and bedding can NOT be done just prior to the transfer of the dog, PLEASE let us know so that we can alert the new owner in advance. Lastly, if you have received a CPCRN “There’s No Place Like A Good Home” Bandana, please be sure the dog is wearing it proudly! Thank you SO much for all you’re doing for these little ones! CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.