Foster Supply Requests CommentsThis field is for validation purposes and should be left unchanged.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 PhoneFoster Dog InformationDog's Name(Required)CPCRN Tag ID(Required)Dog's Gender(Required) Male Female 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 Color(Required) Black Black Brindle Grey Grey Brindle Red Red Wheaten Wheaten White Dog's Weight(Required)Dog's Age(Required)Supply Request(s)Is the dog currently in your home?(Required) Yes No What is the expected arrival date?(Required) MM slash DD slash YYYY Do you need heartworm or flea preventative FORMS?(Required) Yes No What type of supplies are you requesting?(Required) Belly Band (for Foster Boys) Collar, Leash, and/or Harness Flea Prevention Heartworm Prevention Cetirizine Medicated Shampoo Panacur Belly Bands for Foster BoysThe CPCRN bellyband becomes part of a foster home CPCRN supplies. These are NOT given to an adoptive home. They may not be ordered until such time that you have agreed to take in a male foster dog. We generally supply TWO BELLYBANDS per foster home, UNLESS you frequently have more than one foster. Bellybands help male dogs in their housetraining to help prevent marking. These bands remain the property of CPCRN, and do not go with your foster when adopted. Male bellybands are ordered by exact size; therefore; they cannot be ordered prior to your male actually arriving at your home or obtaining prior measurements. Measure AROUND the dog (not lengthwise) in the penis area. Be sure and include the penis in your measurement! Typical measurements for a Cairn would range from 15″ to 20″ (possibly more for a heavier dog).Number Requested(Required)Measurement in inches (around belly area):(Required)Additional NotesCollar, Leash and/or HarnessYour new foster should arrive wearing a correctly fitting and correctly fitted (check the fit yourself-not more than one finger should be able to go between the dog and the collar or harness) collar and harness with a 6 foot leash among other items that come with him/her. If this is not so, please contact us so we can send clean approved CP hardware. Do you need a leash?(Required)All leashes are 6 feet Yes No Do you need an adjustable collar?(Required) Yes No Adjustable nylon collars have a strong plastic, quick-release clasp. The collars used most often are: • M: (5/8″ wide) fit necks 10″ to 15″ and • L: (3/4 ” wide) fits necks 14″ to 20″ We do have several others on hand. Special need collars (rubber) are available for skin issue fosters. Please select a size(Required) Small up to 13″ Medium 12″ – 18″ Large / Xlarge 18″ – 26″ XXLarge 20″ – 28″ Neck Measurement (in inches)(Required)Do you need an adjustable harness?(Required) Yes No Our nylon harnesses are adjustable and the widths vary with the sizes. Be sure to get accurate measurements to get the best fitting harness. • S: (3/8″ wide) up to 13″ for puppies • M: (5/8″ wide) fit chests 12″ to 18″ • L/XL: (3/4″ wide) fit chests 14″ to 26″ • XXL: (1″ wide) fit chests up to 28″ Special need soft harnesses are available for skin issue fosters. Please select a size(Required) Small up to 13″ Medium 12″ – 18″ Large / Xlarge 18″ – 26″ XXLarge 20″ – 28″ Chest Measurement (in inches)(Required)Additional NotesPlease include any notes about the hardware to be supplied or the foster’s need for special hardware due to skin problemsFlea PreventionDO NOT apply any topical flea control product to a dog if the dog needs an immediate bath. First bathe the dog and then apply flea control 3 days later as directed.Agreement I agree to read the instructions thoroughly prior to application of flea preventatives.Due date for next dose of flea protection: MM slash DD slash YYYY Heartworm PreventionDue date for next dose of heartworm prevention: MM slash DD slash YYYY Specialty RequestsBefore ordering speciality items (Cetirizine, Fish Oil, Immune Blend, Liver Support Factors, Medicated Shampoo or Panacur) please discuss with your mentor and get approval. Did you discuss the need for speciality items with your mentor/get approval to order? Yes No CetirizineWere these sent to your foster in the past?(Required) Yes No If Yes, When?Reason Needed(Required)Fish OilWere these sent to your foster in the past?(Required) Yes No If Yes, When?Reason Needed(Required)Immune BlendWere these sent to your foster in the past?(Required) Yes No If Yes, When?Reason Needed(Required)Liver Support FactorsWere these sent to your foster in the past?(Required) Yes No If Yes, When?Reason Needed(Required)Medicated ShampooWere these sent to your foster in the past?(Required) Yes No If Yes, When?Reason Needed(Required)PanacurWere these sent to your foster in the past?(Required) Yes No If Yes, When?Number of Packets Needed(Required)Reason Needed(Required)CAPTCHA
