Personal Information

* First Name: 

* Last Name: 

* Age: 

   Spouse's First Name: 

   Spouse's Last Name: 

   Spouse's Age: 

* Address Line 1: 

   Address Line 2: 

* City: 

* State: 

* Zip Code: 

* Home Phone: 

   Mobile Phone: 

* Will you accept a collect call from us? -Yes   -No

   What is the best time to contact you? 

   E-mail Address: 

   Your Employer: 

   Work Phone: 

   Spouse's Employer: 

   Spouse's Work Phone: 

* Number of children in the house:  None 1 to 2 3 or more

   Ages of the children: 

* Please indicate which best describes your current living situation:  House Condo/Apartment/Townhouse Mobile Home

* Do you own or rent?  Own Rent/Lease Live with parents

   If you rent, name & phone number of your landlord: 

* What type of environment do you live in?  City Suburban Country

* How long have you lived at this address?  Less than 1 year 1 to 2 years 2 to 4 years over 4 years

* Besides your immediate family, are there others residing in your home? -Yes   -No

   Names: 

   Ages: 

* Does your home have a yard? -Yes   -No

   Is it completely fenced in? -Yes   -No

   What type of fence is it and how tall? 

   Will gate be locked with a padlock? -Yes   -No

   Is the fence secured underground as well? -Yes   -No

* Does your home have a pool? -Yes   -No

   If so, is the pool fenced? -Yes   -No

   If so, describe the fence  

   Are you aware that many rottweilers enjoy swimming and if you have an unfenced pool the rottweiler will most likely swim in it? -Yes   -No

Foster Information

* Is someone home during the day? -Yes   -No

   If no, where will the foster dog stay while you are gone? 

* Where will the foster dog be kept most of the time?  Inside Outside Basement Other (specify)

   If other, specify: 

* If kept outside, will you have a dog run/dog house? -Yes   -No

   (Dogs are not to be chained or tied out and left at any time)

* Have you ever owned or fostered a rottweiler before?  -Yes   -No

* Do you prefer a male or female rottweiler?  No Preference Male Female

* Are you willing to foster a puppy? -Yes   -No

* Are you able to provide the foster rottweiler with basic obedience training? -Yes   -No

* Which of the following methods/tools do you use in training a dog: Choke chain, prong/pinch collar, GL/Halti collar, electric collar, food/toy reward, others (describe)?
 

* Briefly describe the methods you will use to discipline a foster dog when it misbehaves (for example, if it eliminates on your carpet).
 

* Are you interested in learning other training or discipline methods? -Yes   -No

* Have you ever read 'Culture Clash' by Jean Donaldson? -Yes   -No

* Do you have other pets? -Yes   -No

   Type: 

   Are your other pets current on all vaccinations? -Yes   -No

* Veterinarian's Name & Phone Number: 

   How did you hear about Phoenix Area Rottweiler Rescue?: 

   List any Humane Societies, Organizations, Breed or Training Clubs you are associated with: 

* We will attempt to provide you with an honest evaluation of temperament on any dog we place in your home for foster care. Do you realize that often the complete history of a rottweiler may not be known and you may encounter some behavioral problems? -Yes   -No

* Are you willing to work with a behaviorist (at PARR expense) to correct these problems? -Yes   -No

   Please provide the name and phone number of three references who can vouch for your ability to care for a pet:

* Reference 1 Name: 

* Reference 1 Phone: 

* Reference 2 Name: 

* Reference 2 Phone: 

* Reference 3 Name: 

* Reference 3 Phone: 

   Space for additional comments:
 

   I certify that the information provided on this form is true & correct. I am also financially able to provide a high-quality kibble and am physically able to care for this animal.

* Signature: 

* Date of signature: 

While we would really appreciate if you submitted this on-line form, you may also print the form out and mail it, with your signature to:

Phoenix Area Rottweiler Rescue
P.O. Box 5662
Peoria, AZ 85385-5662