CCTR: Foster Supply Request

Foster Home Information

First Name*

Last Name*

Email Address*

Enter Email Confirm Email

Street Address*

Apt | Suite or Unit Number

City*

State*

Zip Code*

Phone Number*

Foster Dog Information

Dog Name*

Dog Tag ID*

Dog Gender*

Male

Female

Dog Breed*

Dog Color*

Dog Weight*

Dog Age*

Is The Dog Currently In Your Home?*

Yes

If Not, What Is The Expected Arrival Date?

Supply Requested

Heartworm Or Flea Preventative FORMS*

Yes

Type Of Supply Requested

Select All That Apply

Belly Band (For Foster Boys)

Collar, Leash, and/or Harness

Flea Prevention

Heartworm Prevention

Cetirizine

Medicated Shampoo

Panacur

Belly Bands (For Foster Boys)

Belly bands are used to help male dogs in their housetraining to help prevent marking. These belly bands become a part of your foster home CCTR supplies and remain the property of CCTR. They are NOT given to an adoptive home.
Note : (1) CCTR generally supply TWO belly bands per foster home unless you frequently have more than one male foster. (2) As belly bands are ordered by exact size, they may only be ordered if the male is actually in your home or you obtained prior measurements. (3) Measurements for a cairn are typically between 15" and 20". Measure AROUND the dog in the penis area.

Measurement In Inches (Around Belly Area):*

Number Requested*

Additional Notes

Collar, Leash and/or Harness

Your new foster should arrive wearing a correctly fitting and correctly fitted (check the fit yourself-not more than one finger should be able to go between the dog and the collar or harness) collar and harness with a 6 foot leash among other items that come with him/her. If this is not so, please contact us so we can send clean approved CCTR equipment.

Do You Need A leash?*

All leashes are 6 feet

Yes

Do You Need An Adjustable Collar?*

Yes

Neck Measurement (in inches)*

Please select a size*

Adjustable nylon collars have a strong plastic, quick-release clasp. The collars used most often are: • M: (5/8″ wide) fit necks 10″ to 15″ and • L: (3/4 ” wide) fits necks 14″ to 20″ We do have several others on hand. Special need collars (rubber) are available for skin issue fosters.

Small up to 13″

Medium 12″ – 18″

Large / Xlarge 18″ – 26″

XXLarge 20″ – 28″

Do You Need An Adjustable Harness?*

Yes

Chest Measurement (in inches)*

Please select a size*

Our nylon harnesses are adjustable and the widths vary with the sizes. Be sure to get accurate measurements to get the best fitting harness. • S: (3/8″ wide) up to 13″ for puppies • M: (5/8″ wide) fit chests 12″ to 18″ • L/XL: (3/4″ wide) fit chests 14″ to 26″ • XXL: (1″ wide) fit chests up to 28″ Special need soft harnesses are available for skin issue fosters.

Small up to 13″

Medium 12″ – 18″

Large / Xlarge 18″ – 26″

XXLarge 20″ – 28″

Additional Notes

Please include any notes about the equipment to be supplied or the foster’s need for special equipment due to skin problems

Flea Prevention

DO NOT apply any topical flea control product to a dog if the dog needs an immediate bath. First bathe the dog and then apply flea control 3 days later as directed.

Agreement

I agree to read the instructions thoroughly prior to application of flea preventatives.

Due Date For Next Dose Of Flea Protection:

Heartworm Prevention

Due Date For Next Dose Of Heartworm Prevention:

Specialty Requests

Before ordering speciality items (Cetirizine, Fish Oil, Immune Blend, Liver Support Factors, Medicated Shampoo or Panacur) please discuss with your mentor and get approval.

Did you discuss the need for speciality items with your mentor/get approval to order?

Yes

Cetirizine

Was Cetirizine Sent To Your Foster In The Past?*

Yes

Reason Needed*

Medicated Shampoo

Was Medicated Shampoo Sent To Your Foster In The Past?*

Yes

If Yes, When?*

Reason Needed*

Panacur

Was Panacur Sent To Your Foster In The Past?*

Yes

If Yes, When?*

Number of Packets Needed*

Reason Needed*

Foster Home Supply Request