Volunteer Reference Questionnaire Instructions

Your friend or relative has applied to foster a little dog or volunteer other services for Lone Star Shih Tzu
and Lhasa Apso Rescue of Texas.  Part of the application process is to get to know the applicant by
engaging in a dialog with friends and family.  We are interested in finding out how you feel a foster dog
might be treated within the applicant’s home and what you think of the applicant’s overall character.  If
you don’t mind, please complete the following questions in as much detail as possible.  We know this is
a very lengthy document and we apologize for taking up so much of your time.  However, this is
necessary in order to understand the people with whom we are working and entrusting our dogs.  We
believe this to be critical to ensure the safest and best care for the dogs.  We thank you so much for your
time and for caring.  By completing this form, you are contributing to our rescue’s mission to save dogs.

Highlight and copy the entire questionnaire below.  
Paste it into a new email.  (Click here to open a new email)
Please put "Reference Questionnaire" in the email subject.  
Type in your answers and send to APPLICATIONS@shihtzu-rescue.com

    If you would like a printable version you can fax or mail please click here.
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The Lone Star Shih Tzu and Lhasa Apso Rescue (LSSTLAR) is an all volunteer organization dedicated to the rescue,
rehabilitation and re-homing of abused, abandoned and neglected Shih Tzus and Lhasa Apsos.  We are a 501(c)(3)
charitable organization which means your donations may be tax deductible.

Copyright 2004, Lone Star Shih Tzu and Lhasa Apso Rescue
all rights reserved


Lone Star Shih Tzu & Lhasa Apso Rescue

Volunteer Reference Questionnaire


Applicant’s name:  

Your Name:  
Your Address:   
Your Home Phone:  
Your Cell Phone:  

1. How long have you known the applicant?  

2. How do you know them? (coworkers, personal friends, etc)  

3. What dogs does the applicant have now?  Please list name, breed, sex (neutered or spayed) and age.  

4. Please explain in detail some interaction you have seen between the applicant and their dog(s).  

5. What dogs have they had in the past?  Please list name, breed, sex (neutered or spayed) and age.  

6. What happened to these dogs? (death & cause of death, ran away, stolen, re-homed with a friend or family
member, etc)  

7. Have they ever had any pets hit by a car or with a serious disease or injury?  

8. If yes, what were the circumstances and how did they handle the veterinary care?  

9. What do you think the others in the house feel about a foster dog?  (spouse, kids, parents, etc)   

10. Do the dogs have free run of the secure fenced yard when no one is home?   

11. What kind of a fence do they have?  

12. What condition is the fence in?  

13. Is there any way a small (10 pound) dog could escape from the yard?  

14. Have their pets escaped in the past?  

15. Have they been able to correct the behavior or were they forced to give the pet away?  

16. Is there a doggie door?  

17. Describe their neighborhood and street.  

18. What kind of neighbors do they have?  

19. Do any of the immediate neighbors dislike pets?  

20. How close do they to a busy street?  

21. Describe the interior of their home.  

22. Describe the condition of their front and back yard.

23. What type of people visit their home? (kids, grandkids, step children, etc)  

24. How do these children interact with pets?  

25. If the applicant has children, how do they act?  

26. Are the children respectful of the adults?  

27. Are the adults respectful of the children?  

28. How do the children treat their current pets?  

29. What is the applicant’s experience with puppies?  

30. What is the applicant’s experience with aging pets?  

31. Would you trust the applicant to care for your own dog(s) in their home while you are out of town?  

32. If not, please elaborate.  

33. Are there any other comments you would like to add about the applicant?  


Signature:  
Date:  

Thank you!  We will begin processing the application once we have received this questionnaire.
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