First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Cell Phone*

Alt Email

Date of Birth (include month, day, & year):*

Employer:*

Do you own a vehicle?*

Is everyone in the home on board with the decision to foster a pet?*
Choose one: Yes No

Names & ages of persons in home:*

Is anyone in your home allergic to pets?*
Choose one: Yes No Unknown

Name of animal you are interested in fostering:

What age dog are you interested in fostering?

I prefer to foster a:*
Choose one: Male Female Doesn't matter

Preferred energy level:*
Choose one: Active (daily exercise, play groups) Moderate (daily walks, occasional play group) Couch Potato (leisurely walk)

Preferred size:*
Choose one: Small (<30 lbs) Medium (30-50 lbs) Large (>50 lbs)

How do you feel about crate training?*
Choose one: Never crate Crate only when away Crate over night only Crate while away & overnight

What is the length of time you'd be willing to foster?*
Choose one: Temp - weekly (2-4 weeks) Temp - monthly (2-4 months) Long-term (until adopted or transferred to another rescue) Hospice

Would you be interested in a special needs foster? Check all that apply.

Do you currently have pets?*
Choose one: Yes No

Please list the names, species, & ages of your current pets. *

Are ALL of your pets current they on vaccinations?
Choose one: Yes No

If not, please tell us why.

Are ALL of your pets current on heartworm prevention?
Choose one: Yes No

If not, please tell us why.

Are ALL of your pets altered?
Choose one: Yes No

If not, please tell us why.

Veterinarian (present or former, no matter where located):

What type of home do you live in?*
Choose one: Apartment/Condo Townhouse House

Do you own or rent?*
Choose one: Own Rent

Landlord's name:

Landlord's email address:

Landlord's phone number:

Landlord's mailing address (include city & state):

Do you have a fenced yard?*
Choose one: Yes No

Have you fostered an animal for another organization?*
Choose one: Yes No

Name of organization (including contact person & info):

What type of fencing?
Choose one: Chain link Privacy Other

How would you exercise your foster if you do not have a fenced yard?

Reference #1 - Please list the full name of a personal or professional reference. *Do NOT list a family member.**

Reference #1 - What is your relationship to this person?*

Reference #1 - Please provide a phone number for your reference.*

Reference #1 - Please provide an email address for your reference. (REQUIRED)*

Reference #2 - Please list the full name of a personal or professional reference. *Do NOT list a family member.**

Reference #2 - What is your relationship to this person?*

Reference #2 - Please provide a phone number for your reference.*

Reference #2 - Please provide an email address for your reference. (REQUIRED)*

Reference #3 - Please list the full name of a personal or professional reference. *Do NOT list a family member.**

Reference #3 - What is your relationship to this person?*

Reference #3 - Please provide a phone number for your reference.*

Reference #3 - Please provide an email address for your reference. (REQUIRED)*

If yes, what do you plan to do to avoid allergic reactions