First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone

Alt Email

Text/Pager Email

Please provide name and phone number of who we should contact in the event of an emergency.*

How did you hear about us?*

How many people reside in your household?*

What are the ages of all household members?*

What is your status?*
Choose one: Co-habitant/roommate Domestic partner Married Single

What are your current pets' names, ages, gender, breed/species? If none, reply 'no pets'.*

Do you have a veterinarian?*

If yes, please provide the name of your vet/clinic/hospital and telephone number. Also list names of pets they have cared for. Be sure to call the vet office granting an NBRAN coordinator permission to do a vet check. If no, please enter at least one personal reference (name and telephone number).*

Have you ever owned a Brittany?*

How many Brittanys have you owned?*

What activities are/were you and your dog involved in? (To select more than one option, hold down the Control key when you click with your mouse.)
Choose all that apply: Agility Conformation Hunting Obedience Rally Walking/Hiking Other None

Are you or have you been involved in other rescue efforts? If yes, please explain.*

What area(s) of Brittany rescue would you be interested in? (To select more than one option, hold down the Control key when you click with your mouse.)
Choose all that apply: Foster Care Home Visits Organization/Management Shelter Contact Training Transportation (Canine Railroad)

Please select the length of time you are willing to foster. (To select more than one option, hold down the Control key when you click with your mouse.)
Choose all that apply: 2 - 6 weeks Longer than 6 weeks

Are there times when you would not be able to foster?*

Would you be able to quarantine a dog?*

Would you be willing to tell your vet about your involvement in rescue and discuss the possibility of a discount for rescued Brittanys?*

What are you able to foster? (Check all that apply. To select more than one option, hold down the Control key when you click with your mouse.)
Choose all that apply: Male Female Puppy Young Adult Senior Special Needs Brittany mix Full tail Bonded Pair Under 50 pounds Over 50 pounds

Would you provide adequate food and shelter for the dog at your own expense?*

What brand of dog food would you feed?*

Are you interested in adopting a Brittany?*

In what type of home do you live?

Do you own or rent your home?*

If you rent, please enter your landlord's name and phone number. If not, enter N/A.*

If you rent, have you received the approval of your landlord to have an animal? (Copy of Rental Agreement is required for renters. If you Own, enter Yes.)*

Do you have a secondary residence?*

If yes, where?

Is your yard fenced?*

If no, how will you safely contain your Brittany?*

What type of fence?

Other fence type:

What is the height of the fence?*

What is the approximate size of your fenced/containment area?*

Is there a pond or pool on your property?*

Do you have an outdoor kennel or run?*

Do you have a dog door?*

Will your dog be supervised while outside?*

Will your dog be tied out on a cable or chain?*

If so, for how long?

Have all adults in the home agreed to adopt a rescued Brittany?*

How many hours each day will the animal spend alone?*

Will the animal be kept inside or outside?*

Where will the animal sleep?*

How would you exercise your Brittany?*

Are you familiar with dog training methods?*

Please explain:*

Are you familiar with crate training?*

Do you intend to use a crate?*

Have you successfully house trained a dog using a crate?*

Would you be willing to house train and crate train a foster dog?*

RELEASE AND INDEMNITY • Foster(s) hereby specifically and forever releases and hold National Brittany Rescue and Adoption Network, and all its affiliates (herein collectively referred to as NBRAN) harmless from any and all liability arising from the placement for foster care by NBRAN, or for any other actions taken by NBRAN in accordance with, and in reliance on, the representations foster(s) have made under the terms of this document. Foster(s) agree to indemnify and hold harmless NBRAN for any damages suffered and expenses incurred (including legal fees) in defending any legal action, whether for bodily injuries or death, property damage, breach of contract, or otherwise, whether instituted by foster(s) or by any other person or persons involved with this Brittany arising out of or in consequence of the placement of this dog, in reliance on the representations and warranties Adopting Owner(s) has made in this agreement. *
Choose one: Yes No