GENERAL INFORMATION

Name:

Address:

E-mail address:

Telephone Numbers:

^Home

^Work

^Cell

Which best describes your home:

House
Townhouse
Condo
Apartment
Mobile Home

Do you:

Own

Rent - if so please provide landlord's Name, Address and Phone:
	Name:
	Address:
	Phone:

If you rent, do you have permission to foster animals?

Yes    No

Do you live with parents?

Do they agree with fostering?

Yes    No

Foster Preferences

Which type of animal would you prefer to foster?

Dog    Cat

Which age would you prefer to foster?

Adult (1 yr+)
Young/Newborn (less than a year)
Orphaned Newborns (requires around the clock care and supervision)
Mother with newborns
Special Needs

Would you be willing to care for a foster that is ill and/or needs medication or is disabled in some way? Please describe.

Are there any specific requirements you have for a foster animal? (temperment, age, gender)

Do you feel you could foster more than one animal at one time?

How long will you be able to foster?

Up to one week
Up to two weeks
Up to one month
As long as necessary
Other:

Would you be able to serve as an emergency foster care provider for short periods of time?

Yes    No

Housing

How many hours during the day will the foster be alone?

Where will the foster animal be kept while you are out?

Where will the foster animal be kept while you are at home?

Where will the foster animal be kept at night?

Will you be able to keep the foster animals separated from your own animal for at least 2 weeks (14 days) and possibly the entire fostering period?

Yes    No

Transportation

Will you be able to transport foster animals to the veterinarian for regular or emergency appointments?

Will you be able to transport foster animal to PetsMart or other locations for adoptathon and other events? (Adoptathons are typically held on Saturdays from 12-4)

Experience

Do you have any fostering experience? If so, please explain (including type of animal(s), breed, sex, age, etc.).

What experience do you have with the type of animal(s) you wish to foster?

Resident Pet Information

Please list the number of all pets currently part of your household:

Have you had any other pets in the past five years not listed above? If so, please describe what happened to these pets.

Do any of your pets have special needs? If so, what are they and how are they treated?

Do you feel your resident pets will get along with a foster animal? Why or why not?

Household Information

List the members of your household (beginning with yourself)::

If there are young children in your house what measure will you take to protect both the foster animal and the child?

Who will be responsible for day to day care of the foster animal?

In the space below, please provide a reference we can contact.
It Cannot be a family member:

Reference

Name:

Address:

E-mail address:

Telephone Numbers:

^Home

^Work

^Cell

Please list the name, address and phone number of your current veterinarian

Veterinarians Name:

Address:

Name of Veterinarians practice:

Phone Number: