Foster application




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Rakki-Inu Akita Rescue, Inc
FOSTER APPLICATION

Be sure to complete all six pages. Incomplete applications will not be processed. Please use the backs of the pages if necessary for further explanations
Applicant Name: _________________________­­________________________________

Co-Applicant Name: ______________________________________________________

Home Telephone: _____________________________Cell Phone: ___ ___________________

Address: _____________________________________________________________________

City: ___________________State: ____________________ Zip Code: _______________

Applicant Drivers License Number: ______________________State Issued: _____________

Co-Applicant Drivers License Number: ____________________State Issued: _____________

E-mail address(s): _____________________________________________________________

How did you hear about Rakki-Inu Akita Rescue, Inc.:

Friend ____ Website ____ If so which one? ________________________________________

Web Search engine ____ If so which one? _________________________________________

Magazine Ad ___ If so which one? ________________________________________________

Why do you want to adopt an Akita? ______________________________________________ _____________________________________________________________________________

_____________________________________________________________________________

Are you currently applying or have you applied to any other rescue group, shelter or humane society to adopt/foster an animal ? If Yes, please give the name of the group and its contact information._________________________________________________________________________________________________________________________________________________
PETS: (If additional space is needed please use back of the following pages)

1. Type: Dog Cat Other: ___________ Breed: __________ Name _______________

Sex:  Male  Female Vaccinations kept up-to-date:  Yes  No

Kept on heartworm prevention:  Yes  No Received routine vet care:  Yes  No

Spayed/Neutered?  Yes  No If not, why not?___________________________________

Where did you acquire this pet from (name, address and telephone number): ____________

_____________________________________________________________________________

_____________________________________________________________________________

What happened to this pet? (If still owned please answer “Still own”, if deceased explain how and when)

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________


2. Type: Dog Cat Other: ___________ Breed: __________ Name________________

Sex:  Male  Female Vaccinations kept up-to-date:  Yes  No

Kept on heartworm prevention:  Yes  No Received routine vet care:  Yes  No

Spayed/Neutered?  Yes  No If not, why not?__________________________________

Where did you acquire this pet from (name, address and telephone number): ____________

_____________________________________________________________________________

_____________________________________________________________________________

What happened to this pet? (If still owned please answer “Still own”, if deceased explain how and when )

_____________________________________________________________________________

_____________________________________________________________________________


3. Type: Dog Cat Other: ___________ Breed: ____________ Name______________

Sex:  Male  Female Vaccinations kept up-to-date:  Yes  No

Kept on heartworm prevention:  Yes  No Received routine vet care:  Yes  No

Spayed/Neutered?  Yes  No If not, why not?________________________________

Where did you acquire this pet from (name, address and telephone number): _______________

_____________________________________________________________________________

_____________________________________________________________________________

What happened to this pet? (If still owned please answer “Still own”, if deceased explain how and when)

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Have you ever taken a dog through obedience class?  Yes  No

Are you willing to attend obedience classes?  Yes  No

How much do you think the yearly cost is for routine vet care (shots, heartworm test and meds, exams) ?__________________

How much do you think the monthly cost is for a premium dog food and heartworm medication ? _________
MILITARY PERSONNEL ONLY

If you had a pet in the past what happened to it when you were deployed?_________________


____________________________________________________________________________
If you adopt a dog and are then deployed, what will you do with the dog?__________________

_____________________________________________________________________________

Have you taken your pets with you when you were transferred, even overseas?______________

If not, what arrangements did you make for your pet?__________________________________


_____________________________________________________________________________
If you adopt a dog and get transferred, what will you do with your dog?____________________
_____________________________________________________________________________
SINGLE OWNERS ONLY

What will you do if you become involved with someone who does not like or is afraid of your dog?__________________________________________________________________________

_____________________________________________________________________________

What will you do if you become involved with someone who has children who are afraid of or allergic to your dog?_____________________________________________________________

_____________________________________________________________________________

What will you do if you become involved with someone who is or becomes allergic to your dog? _____________________________________________________________________________

_____________________________________________________________________________
COUPLES ONLY

What will you do with your dog if you break up or divorce?_____________________________

_____________________________________________________________________________

If you are childless, are you planning on having children during the lifetime of your dog? _____

What will you do with your dog if you have children?__________________________________

_____________________________________________________________________________


HOUSING INFORMATION:

How many adults living in your household? _______What relationship to you? ____________


Are there children residing in your household/visiting on a regular basis?  Yes  No

Child’s age: ________  Male  Female

Child’s age: ________  Male  Female

Child’s age: ________  Male  Female

Child’s age: ________  Male  Female

If interested in fostering, do you have the ability to keep the Akita separate from other pets?

Yes __ No___ If yes, how will you do this?__________________________________________

__________________________________________________________________________________________________________________________________________________________

Does your homeowner’s insurance allow you to have an Akita? Yes____ No______

Is there anyone home during the day?  Yes  No If so who? ______________________

Do you do day care in your home?  Yes  No

In relation to your residence, do you:  Own  Rent

If renting, does the lease permit large dogs, specifically an Akita?  Yes  No (If yes, attach copy of lease to application please. The application will not be processed without proof that Akitas are permitted on leased/rental premises)

How long have you resided at your current residence? _________________________________

If less than two years, give previous address: ________________________________________

_____________________________________________________________________________

And how long did you live there? _____________
What is your lot size? ___________ Is it fenced?  Yes  No If so, fencing material and height: _______________________________________________________________________

If you do not have a fenced yard, are you willing to provide one or a kennel run?  Yes  No

Where will the dog stay during the day? ___________ At night? _______________________

If there are no children or other animals in your house, are there foreseeable times the Akita will have to spend visiting with children or other animals?  Yes  No

If so, please explain: ___________________________________________________________

_____________________________________________________________________________

Are there any unusual circumstances to which the Akita will have to adjust?  Yes  No

If so, please explain: ____________________________________________________________

_____________________________________________________________________________

Who will be the primary caregiver?_________________________________________________

Do all family members want to adopt/foster an Akita?  Yes  No Who is unsure? ______

_______________Why? ________________________________________________________

____________________________________________________________________________

_____________________________________________________________________________

Does anyone in the family have seasonal or pet allergies?  Yes  No

If yes please explain type of allergies and whether medical care is being provided: _________

_____________________________________________________________________________

Can you devote a minimum of one-hour daily (aside from feeding, grooming, letting the Akita in and out) of quality time with your Akita?  Yes  No

Please list your hobbies and interests, (i.e., sports, theatre, reading, etc.): __________________

_____________________________________________________________________________


OCCUPATIONAL INFORMATION:

Applicant’s occupation: ____________________ Work hours: _____________________

Name of Business: ______________________________________________________________

Address: _____________________________________________________________________

City: __________________________ State: _________________ Zip: __________________

Work Telephone: ________________________ How long employed: ______________

If one-year or less, please provide the name, address, and telephone number of previous

employer: _____________________________________________________________________

_____________________________________________________________________________
Co-Applicant’s occupation: __________________ Work hours: _____________________

Name of Business: ______________________________________________________________

Address: _____________________________________________________________________

City: __________________________ State: _________________ Zip: __________________

Work Telephone: ________________________ How long employed: ______________

If one-year or less, please provide the name, address, and telephone number of previous employer: ____________________________________________________________________

_____________________________________________________________________________
If anyone else in your household will be caring for the Akita, please provide the following:

Name: _____________________________ Work Hours: ___________________________

Name of Business: ______________________________________________________________

Address:______________________________________________________________________

City: __________________________ State: _________________ Zip: __________________

Work Telephone: ________________________ Age: ___________________________


LEGAL INFORMATION:

Have you or anyone in your household ever been charged with and/or convicted of spousal, child, or animal abuse, neglect or cruelty?  Yes  No

If so, please explain: ____________________________________________________________

Have either you or the co-applicant currently filing, about to file, or filed for bankruptcy within the past 5 years:  Yes  No

If so, please explain who, when and why: _____________________________________________________________________________

Are you informed of local zoning and dog ownership ordinances?  Yes  No

Will you be in compliance?  Yes  No
VETERINARIAN REFERENCES:

Please provide the following information for any veterinarians that you use, or have used in the past, to treat your pets. If additional space is needed, please use the back of this page.


Name: _________________________________ Telephone Number: ____________________

Address: _____________________________________________________________________

City: __________________________ State: _________________ Zip: __________________

Pet(s) treated there (please provide names): _________________________________________

Approximate Dates Used: From: ________________ To: _________________________
Name: _________________________________ Telephone Number: ____________

Address: _____________________________________________________________________

City: __________________________ State: _________________ Zip: _________________ Pet(s) treated there (please provide names): __________________________________________

Approximate Dates Used: From: ________________ To: _________________________



PERSONAL REFERENCES:

Please provide the following information for at least two individuals, who are not related to you, who have known you at least one year and preferably know your current or past pets.


1. Name: _________________________ Telephone Number: ____________________

Address: _______________________________________________________________

City: _______________________ State: _________________ Zip: _______________
2. Name: _________________________ Telephone Number: ____________________

Address: _______________________________________________________________

City: __________________________ State: _________________ Zip: ___________________
May we visit your home?  Yes  No

May we check your references to verify the information you have provided?  Yes  No

Remembering that Akitas rarely co-exist peacefully with same sex of any breed, and the majority of rescue dogs are adults or young adults, what sex and general age category do you have in mind to foster? Age_______  Male  Female

Although we cannot choose dogs by coat color or coat length, do you have a preference? Color?_____________________ Would you consider adopting a long coat? Yes  No


Your social security number will be requested if you adopt from or foster for us. For those of you worried about privacy concerns, this information is not stored in any computer files. We do not sell information given to us.  All information given in the application or on the adoption contract will be used for adoption purposes only, and will not be released for any other purpose without your permission. We are happy to give references from previous adopters.
AGREEMENT:
By signing this legally binding agreement you, the undersigned, are stating that you are at least 18 years of age and that you fully understand that any misrepresentation of yourself or any untruths herein this application that are discovered at a later date will invalidate any adoption agreement, disqualify you from being an adopter from RIAR, and RIAR will immediately remove, without notice, any and all RIAR dogs from your care. In addition, by signing this agreement you, the undersigned, are stating that you fully understand that any misrepresentation of yourself or any untruths herein this application that are discovered at a later date that disqualify you from being an adopter may be shared with other humane organizations if they query RIAR.
Applicant Signature___________________________________ Date: ___________________
Co-Applicant Signature_________________________________ Date: ___________________

Should you have any questions please feel free to contact: Kira Brown: 757-831-4200 rakki.inu.akita.rescue@gmail.com or Kimmi Pecora: 757-567-7329


Please return completed adoption application to:
Kira Brown

1952 Laskin Rd,

Ste 505

Virginia Beach, VA 23454
Please answer the following YES or NO questions. This will aid us in assessing or helping to add to your knowledge of the breed’s nutritional, health and emotional needs.
Put Yes or No in the blanks next to each statement. If you don’t fully understand the statement, or don’t know the answer, circle the blank so we can discuss that statement with you.

THERE IS NO PASS OR FAIL. THIS IS FOR INFORMATIONAL PURPOSES ONLY





Do dogs have individual nutritional needs? ____

Do dogs need vitamin supplements? ____

Are certain kinds of table scraps okay? ____

Is Chocolate deadly to dogs? ____

Should Akitas ever have fresh fruit?____

Does diet affect on hip dysplasia?____

Is lots of running and jumping good for growing pups? ____

Is raw beef bad for dogs? _____

Do Akitas love fish? _____

Should fish, poultry, and pork be cooked? ____

Are all major brands of dry dog food complete and balanced nutrition?____

Is canned food better than dry food? ____

Are semi moist foods great for dogs?____

Are fresh veggies good for dogs?____

Are rawhide or nylon bones safer than real bones?____

Are boiled beef knuckles OK? ____

Should dogs have routine vaccinations?____

Should dogs have routine wormings?____

Should a dog’s rectal temperature be 101-102?____

Do dogs get tapeworms from fleas?____ and from raw meat?____

Do dogs get heartworm from mosquitoes?____ or from spoiled food?____

Can Akitas die from bloat?____

Unlike people, can dogs eat and drink all they want just before or after heavy exercise?____

Do dogs get cavities or dental infections?____ or plaque?____

Can you diagnose thyroid imbalances by coat condition?____

Do dogs have allergies like people?____

Are runny eyes common in Akitas?____

Are skin rashes common in Akitas?____

Can dogs reason like people do?____

Is house breaking easy with Akitas?____

Do Akitas need firm discipline?____

Does a family pet need obedience training?____

If properly trained, will an Akita still fight with other dogs?____

Do Akitas love all kids?____

Do routine baths help prevent skin conditions?____

Do dogs experience emotions?____

Is it cruel not to let a dog run loose once in a while?____

Is it important that children be taught how to interact with dogs?_____

Does OFA certification mean the dog will not develop or produce hip dysplasia?____

Is VWD a problem in Akitas?____

Is Auto Immune Disease hereditary?____

Do you know what OFA, CERF, VWD, Thyroid, and/or Auto Immune means? ______.

Do you feel uncomfortable answering these questions?____

If so, why___________________________

Do you feel your privacy was invaded?____

Are you pleased we want to know all about you and your lifestyle?____


How can these forms be improved? _______________________________________________


_____________________________________________________________________________







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