Foster Volunteer Name* First Last Phone*Email* Foster Animal Name(s)* For which CHS location are you fostering?* Newington, 701 Russell Road Waterford, 169 Old Colchester Road (Quaker Hill) Westport, 455 Post Road East This questionnaire is used to help CHS find the best possible home for your foster pet and prepare the new family with information about his/her history. Please complete it as completely and accurately as possible.Household Information and Social BehaviorWhen you first brought your foster dog home, how did he/she react? Friendly/affectionate Aloof Scared After adjusting to your home, how was your foster dog? Friendly/affectionate Aloof Scared Including yourself, please record all individuals by first name only who lived with this dog, their age range, gender and any additional notes you wish to add.Did your foster dog interact with any pets in the home? (Check all that apply) Dogs Cats Small Animals Birds Reptiles If your foster dog interacted with dogs, please note breed, age and sex of dog. How did your foster dog typically behave towards men he/she knows? (Check all that apply) Unknown Friendly Fearful Shows teeth/Growls Snaps Bites How did your foster dog typically behave towards women he/she knows? (Check all that apply) Unknown Friendly Fearful Shows teeth/Growls Snaps Bites How did your foster dog typically behave towards children he/she knows? (Check all that apply) Unknown Friendly Fearful Shows teeth/Growls Snaps Bites How did your foster dog typically behave towards men he/she does not know? (Check all that apply) Unknown Friendly Fearful Shows teeth/Growls Snaps Bites How did your foster dog typically behave towards women he/she does not know? (Check all that apply) Unknown Friendly Fearful Shows teeth/Growls Snaps Bites How did your foster dog typically behave towards children he/she does not know? (Check all that apply) Unknown Friendly Fearful Shows teeth/Growls Snaps Bites How did your foster dog typically behave towards dogs he/she knows? (Check all that apply) Unknown Friendly Fearful Shows teeth/Growls Snaps Bites How did your foster dog typically behave towards cats he/she knows? (Check all that apply) Unknown Friendly Fearful Shows teeth/Growls Snaps Bites How did your foster dog typically behave towards dogs he/she does not know? (Check all that apply) Unknown Friendly Fearful Shows teeth/Growls Snaps Bites How did your foster dog typically behave towards cats he/she does not know? (Check all that apply) Unknown Friendly Fearful Shows teeth/Growls Snaps Bites How would you describe your foster dog's personality? (Check all that apply) Playful Vocal Friendly Affectionate Hyper Independent Shy Fearful Quiet Aloof Fearless Couch Potato How does your foster dog typically respond when an unfamiliar person approaches or enters the yard or house? (Check all that apply) Friendly Afraid Barks Shows teeth/growls Snaps/bites Other Please give us details about your foster dog's behavior around unfamiliar people.How active is this dog? Very active Somewhat active Inactive How vocal is this dog? Very vocal Somewhat vocal Non-vocal Does your foster dog like to chase any of the following? (Check all that apply) Joggers Bicycles Cars/motorcycles Skateboarders/Roller blades Outdoor cats Indoor cats Birds Wildlife Does your foster dog have any bad habits (i.e. stealing food, raiding the trash, etc.)? Is your foster dog frightened of anything (i.e. fireworks, etc.)? How does this dog behave in the car? Loves it! Calm/quiet Jumping/hyper Gets car sick Scared RoutineIs this dog housebroken? Yes No Is this dog paper trained? Yes No Is this dog crate trained? Yes No Did your foster dog have accidents in the house? Yes No If the dog had accidents, how often? Daily Weekly Once in a while How did your foster dog let you know he/she had to go out? How many hours was your foster dog left alone per day? Never 1-3 hours 4-8 hours 9-12 hours Over 12 hours Where did this dog stay when alone? When left alone, did your foster dog display any of the following behaviors? (Check all that apply) Destroy household items Urinate/defecate Bark for long periods of time Break out of crates Destroy furniture/home None of this Other If other, please describe. Where did your foster dog typically stay at night? What are your foster dog's favorite games and toys? When playing, did your foster dog do any of the following behaviors? (Check all that apply) Jump Growl/vocalize Bark Mouth/bite lightly Bite hard None of this Other If other, please describe. Was your foster dog allowed on furniture? Yes No TrainingDoes your foster dog know any of the following commands? (Check all that apply) Sit Stay Down Come Heel Give paw Does your foster dog perform these reliably? Yes, all the time Yes, if I have a treat Yes, if I have a toy No, he is unreliable No, not when he's distracted No, not when he's outside When off leash, does your foster dog return when called? Yes No Sometimes Never allowed off leash Has your foster dog ever escaped your property? Please explain.BehaviorHas your foster dog ever bitten anyone? Yes No Date of the bite. MM slash DD slash YYYY If yes, did this bite break skin? Yes No Details: Has your foster dog every snapped at anyone? Yes No Details: If yes, did this behavior occur when the dog was in pain? Yes No If yes, did this behavior occur when someone was breaking up a dog fight? Yes No Has your foster dog ever attacked another animal? Yes No Details: Does your foster dog bark, growl or snap when strangers approach him/her? Yes No Details: Has your foster dog ever been aggressive over food in the following situations? (Check all that apply) With men With women With children No history of this behavior Has your foster dog ever been aggressive over bones/rawhides/toys in the following situations? (Check all that apply) With men With women With children No history of this behavior Has your foster dog ever been aggressive when sitting next to or on a family member in the following situations? (Check all that apply) With men With women With children No history of this behavior Has your foster dog ever been aggressive when moved off furniture by the following individuals? (Check all that apply) With men With women With children No history of this behavior If you answered yes to any of the questions about aggression immediately above, please explain in detail.Adoption Memo: Please write a few sentences about your foster dog for use in their adoption write-up.
