Foster Application General Information Name:*FirstLastMI Address Street Address City State Zip Code Home Phone:* Mobile Phone:* E-mail:* Marital Status:*SingleMarriedPartner Spouse's or Partner's name:*FirstLast Spouse or Partner's Mobile Phone Number:*Home Information What type of Dwelling do you live in?*Select valueApartmentCondoHouseTownhome Do you own or rent?*OwnRent Your landlord's name?* Your landlord's phone number:* Does your landlord have any breed or size restrictions?*NoYes What are the Restrictions?*Yard Information Do you have a yard?*NoYes Is it completely fenced?*NoYes Fence type?*Select valueChainlinkChicken WireWoodOther How high is your fence & gates at the lowest point?* How high is your fence & gates at the highest point?*Children Information Are there, or will there be, any children living or staying in your home?*NoYes How many children? * Age(s) of the children in your home?* What is the status of the children in your home?*Select valuePermanentTemporaryOther Resident Information Are there, or will there be, anyone else living or staying in your home?*NoYes What is the status of the residents in your home?*Select valuePermanentTemporary How Many other residents?* What relation are they to you?*Medical Information Does anyone in your household have allergies?*NoYes What is/are the allergy/allergies?*Employment, Reference, and Contact Information Are you employed?*NoYes Name of employer:* Employer address: Street Address City State Zip Code Employer phone:* Is your Spouse or Partner Employed?*NoYes Spouse's or Partner's Employer?* Spouse's or Partner's Employer Address? Street Address City State Zip Code Spouse's or Partner's Employers Phone? *Contact Information Non-Family Contact Name:* Non-Family Contact Phone:* How long have you known him or her?*Pet InformationDog Information Are there any dogs in your house or on your property?*NoYes How many dogs do you have on your property?* What is/are the/their breed(s), age(s), and sex(es) of the dog(s)?* Are all of the dogs spayed or neutered?*NoYes If the dogs are not all spayed or neutered, Why?* Do any of the dogs have health or behavioral issues?*NoYes If so, what health or behavioral issues do the dogs have? *Cat Information Are there any cats in your house or on your property?*NoYes How many cats do you have on your property?* What is/are the/their breed(s), age(s), and sex(es) of the cat(s)?* Are all of the cats spayed or neutered?*NoYes If the cats are not all spayed or neutered, Why?* Is/are the cats indoor, outdoor, or both?*Select valueIndoorOutdoorBoth Do any of the cats have health or behavioral issues?*NoYes If so, what health or behavioral issues do the cats have?*Other Animal's Information Do you have any other pets in your house or on your property, (i.e. birds, fish, rabbits, reptiles, etc..)?*NoYes What species are they?* How many of each species?* Do you have any farm animals on your property, (i.e. chickens, horses, sheep, goats, etc..)?*NoYes What species of farm animals are they?* How many of each farm animal species?*Veterinarian Information Do you have Veterinarian?*NoYes Veterinary Clinic Name:* Veterinary Clinic Address: Street Address City State Zip Code Veterinary Clinic Phone:* Veterinarian's Email:Foster Experience and Information Why are you interested in fostering?* Have you fostered before?*NoYes For what organization?* When were you a foster?* How long were you fostering?* What species (dog, cat, etc) and breeds of animals have you fostered?* Do you have any breed restrictions for fostering?*NoYes If so, which breeds will you not foster?* What species of animal(s) are you willing to foster?* If a dog, what size(s)?*Select valueSmall (under 35 lbs)Medium (35-65 lbs)Large (65-100 lbs)Extra Large (100 lbs)All Sizes Are you able to foster more than one animal at a time?*NoYes If yes, how many animals can you foster?* Are you able to foster a pregnant or nursing mom?*NoYes Have you had experience in this area?*NoYesMiscellaneous Information What is the longest period of time the pet will be alone?* How often will this happen?* Will you ever be transporting the dog in the back of an open pickup?*NoYes What will happen to the pet if you relocate?* Why did you choose this particular animal? * Please check all that apply to your new animal:*CompanionFamily PetGuardHuntingWatch DogOther Additional Comments: Date* reCAPTCHASubmitReset Support 2017-04-05
