Date

New Application or Updated Information?

First Name

Last Name

Street Address

City

State

Zip

Home Phone

Cell Phone

Work Phone

Email Address

Age of Applicant

Occupation(s) of Applicant

Please list household members (Name/Age/Relationship to you)

Please list other pets in your household (Name/Age/Type of pet/Gender/Altered)

How did you hear about FBVillage?

Have you volunteered, or are currently volunteering, for any other Rescue Groups?

If yes, please give the name of the Rescue Group and describe your role.

Are you interested in Home Checking?

Are you interested in Transporting?

Are you interested in Fundraising?

Do you have Other Skills to share?

If yes, please describe

Are you interested in Fostering?

Are you familiar with the health problems of brachycephalic (short-nosed) dogs?

Are you familiar with French Bulldogs?

What is your experience working with dogs in general – please give details

What is your experience with rescue dogs in particular – please give details

Is your yard fenced?

If yes, type of fence

Do you have a pool?

If yes, is it fenced?

Do you live in a

Do you own or rent?

Where will the dog spend the most time

Is anyone home during the day?

If not, where will the Foster Dog stay?

For how long?

Where will the Foster Dog sleep at night?

Will you travel with the Foster Dog?

If not, where will the Foster Dog stay?

Veterinary Reference – Name

Veterinary Reference – Address

Veterinary Reference – Telephone

Breeder or Rescue Reference – Name

Breeder or Rescue Reference – Address

Breeder or Rescue Reference – Telephone

Do you intend to adopt another dog in the next six months?

What additional information should we have in order to fairly evaluate your application?