Name:

Address:

Phone:

Email:

What are you interesting in doing:

____ Home visits for adoptions

____ Rescuing dogs in need

____ Fostering dogs in need

____ Transporting dogs by car

____ Transporting dogs in plane

____ Setting out HUA literature at offices

____ Organizing pet store protests in your area

____ Artistic work

____ Doing Internet research

____ Collecting items for auction

____ Helping with publicity

Tell us about yourself:

Do you have a fenced yard?

Do you have children?

If so, what ages?

Do you have dogs and cats?

If so, what breed?

Do your dogs or cats like other animals?

Are you companion animals altered?

Is there someone home during the day?

Where would a foster dog stay while you were out?

How long could you keep a foster dog?

Can you get a foster dog medical care?

Can you handle a special needs dog?

If so, what kind of needs, eg. medical problems, blind, deaf, aggression.

How far would you be willing to drive to do a home visit for a potential adoptive family?

How far could you drive a companion animal to a new home?

Other information you think is important:

Thank you on behalf of all the dogs and cats in need throughout this country.