If there is a particular dog you are interested in, what is his/her name?
Full Legal Name:
First Name
Last Name
Age
Home Phone #
(example: 555-123-4567)
Cell Phone #
(example: 555-123-4567)
Work Phone #
(example: 555-123-4567)
Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Occupation/Title
Employer’s name and contact information
Do we have your permission to contact your employer to verify employment?
Yes
No
Spouse’s/Partner's/Other Adult's Name
Spouse's/Partner's/Other Adult's Age
Spouse's/Partner's/Other Adult's Occupation
Your Email Address
Spouse's/Partner's/Other Adult's E-mail Address
Do you have children living with you?
Yes
No
If yes, what are their names and ages?
Otherwise, please enter N/A
Please note, homes with children under 16 years of age will not be considered.
Would you be willing to travel by car or airplane to pick up a rescue?
Yes
No
What situations would cause you to not be able to keep this dog?
Do you understand that in the event you are no longer able to keep this dog, you are required to return it to American Brussels Griffon Rescue Alliance/American Affenpinscher Rescue?
Yes
No
Please provide a brief paragraph describing yourself (hobbies, interests, activities):
Which of the following best describes your current residence?
Single Family Home
Duplex
Town House
Apartment
Condo
Mobile Home
Rent
Own
If you rent or lease, the following information is required. If you own your home, please enter N/A:
Name of Landlord
Landlord's Home Phone #
(example: 555-123-4567)
Landlord's Work Phone #
(example: 555-123-4567)
Landlord's Address
Landlord's City
Landlord's State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Landlord's Zip Code
Do you have a securely fenced yard on your property that will keep a small dog safely contained?
No
Yes
If Yes, what type of fence?
Wood
Chain Link
Block
Other
If other, please describe
How high is the fence?
Is your fenced yard directly accessible from your home?
No
Yes
Do you have a doggy door with access to your yard or a porch?
No
Yes
Will your foster dog have access to the doggy door when you are not at home?
No
Yes
What do you use to secure your gate(s)?
Who has access to your yard (meter readers, neighbors)?
How do you plan to allow your foster dog to relieve itself and/or exercise?
How often do you take your dog for walks or plan to take your new dog for walks?
Do you own a swimming pool?
No
Yes
If yes, is it secured?
No
Yes
Please explain how pool is secured:
Will the animal have access to it?
No
Yes
Do all adults in the household work full time?
No
Yes
Approximately how many hours each day will your foster dog be left alone?
Where will the foster dog be kept when left alone? Please explain.
Do you have any travel plans for the first 6 months while you are fostering a Griff or Affen?
If yes, please explain:
List all other animals that you currently own including Name, Breed, Age, Sex, Spayed/Neutered (Yes/No) and How Long You Have Owned:
If you have had pets in the past, what happened to them? Please list each past pet including name, breed, age, sex, spayed/neutered (Yes/No), length of time with you and reason they are no longer with you:
Under what circumstances do you believe a pet should not be spayed or neutered?
Are there any restrictions on the number of dogs you may keep where you live?
No
Yes
If yes, how many are you allowed to have?
Does anyone in your home have allergies to animals?
No
Yes
ABGRA/AAR will provide for all medical care, heartworm and parasite preventative when requests are submitted and approved in advance. Receipts for reimbursement must be provided to the ABGRA/AAR Treasurer even if pre-approval was requested and received. Are you prepared to assume the responsibilities of feeding, bathing, grooming and caring for your foster Griffon or Affen, including emotional rehabilitation for a traumatized dog and crating for a dog going thru heartworm treatment?
No
Yes
Vet Reference
Please note, an excellent veterinary reference is necessary in order to be considered.
Do you have a veterinarian now, or one that you have used in the past?
No
Yes
Vet's Name
Vet's Address
Vet's City
Vet's State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Vet's Zip Code
Vet's Phone Number (example: 555-123-1234)
Will you follow all Veterinarian instructions provided and administer all prescription medications and Heartworm Preventative to your Foster Griffon or Affen?
No
Yes
Will you obtain pre-approval for all medical care from your ABGRA/AAR contact/coordinator?
No
Yes
Will you negotiate a rescue discount with your veterinarian or locate a low-cost veterinary clinic in your area to provide economical care for your foster dog?
No
Yes
Will you stay in close contact with your ABGRA/AAR contact person and keep him/her appraised of progress, problems, medical issues, and updates on you foster dog?
No
Yes
Are you ready to recognize that while your input is valued, responsibility for final decisions about the future of all of our Rescues lies with ABGRA/AAR?
No
Yes
Will you advise ABGRA/AAR if you are planning to take your foster Griffon or Affen out of town or state for family visits or recreation?
No
Yes
Although ABGRA/AAR does not accept vicious dogs into our program, we do not know the histories of many of our rescues. Are you prepared to contact ABGRA/AAR immediately if your Foster Griffon or Affen bites anyone or seriously injures another pet?
No
Yes
Will you keep the dog confined in a fenced yard when let outdoors, walk/exercise the Foster Griffon or Affen on lead regularly and allow the dog to live indoors?
No
Yes
Do you understand that Griffons and Affens are known for being "barkers" and that your foster Griffon or Affen may not be housetrained?
No
Yes
Do you understand that Griffons and Affens can be shy and aloof with new people?
No
Yes
Foster parents are encouraged to maintain an "Aunt" or "Uncle" relationship with the Griffon or Affen in their care. However, occasionally the foster parent and the foster Griffon or Affen will bond so completely that adoption into this home is best for the Griffen or Affen and family. Do you understand that if you wish to adopt your Foster Griffon or Affen you must complete the Adoption Application & Adoption Agreement and make a donation, as would any other adopter?
No
Yes
Are you willing to allow a ABGRA/AAR representative to visit your home by appointment?
No
Yes
Personal References (Other than relatives):
Name of First Reference (Person not related to you)
Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Phone (example: 555-123-1234)
Relationship to you
Do they have pets? If so, please describe:
Name of Second Reference (person not related to you):
Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Phone (example: 555-123-1234)
Relationship to you
Do they have pets? If so, please describe:
How did you hear about the American Brussels Griffon Rescue Alliance/American Affenpinscher Rescue?
Would you be willing to help a Brussels Griffon or Affenpinscher in need by:
Making a visit to a local shelter to I.D.?
Conducting local home visits for forever homes?
Helping to transport?
Fostering a Griff or Affen with special needs?
I hereby forever release, discharge, and agree to hold harmless and indemnify American Brussels Griffon Rescue Alliance; its board of directors; and its members, Officers, and agents from all claims, demands, actions, causes of action, or liability of any kind whatsoever arising as a result of or in connection with the fostering or adoption of a dog sponsored by this organization.