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2. Name*
3. Address*
5. City*
6. Zip
8. Cell Phone
9. Work Phone
10. Home Phone
12. Drivers License Number*
13. Email Address*
15. Do You:*

    1. own your own home
    2. rent or rent-to-own
16. Type of Dwelling:*

    1. single family house
    2. apartment
    3. condo
    4. mobile home
    5. other
18. If you rent or rent-to-own, list the contact information of your landlord, president or manager of condo association, apartment or park.
19. Name
20. Phone Number
22. Name (Pet 1)
23. Type
    -- Select One --CatDogFerretBirdPigRodent (mouse, rat, hampster, Guinea pig)
24. Sex

    1. Male
    2. Female
25. Spayed or Neutered?

    1. Spayed
    2. Neutered
    3. Neither
27. Date of Last Vaccination
28. How Long Owned?
30. Name (Pet 2)
31. Type
    -- Select One --CatDogFerretPigRodentBird
32. Sex

    1. Male
    2. Female
33. Spayed or Neutered?

    1. Spayed
    2. Neutered
    3. Neither
35. Date of Last Vaccination
36. How Long Owned?
38. Any additional pets, describe:
40. What other pets have you owned in the past?
42. What happened to them?
44. Have you ever surrendered an animal to a shelter or animal control facility?

    1. Yes
    2. No
45. Describe the circumstances:
47. Who is your veterinarian or vet clinic?
49. How many adults live in the household?
    -- Select One --12345 or more
50. How many children live in the household?
    -- Select One --12345 or more
51. Ages of the children
52. Who will be primarily responsible for the animal while you are at home?
54. Does anyone in the household have an allergy to pets dander?

    1. Yes
    2. No
55. If yes, please explain:
57. Fostering Experience:
    Have you fostered an animal before, and if so, for what group?
59. Will you foster an animal that has been abused?

    1. Yes
    2. No
60. Will you foster an animal needing neonatal care?

    1. Yes
    2. No
61. Will you foster an animal with medical issues?

    1. Yes
    2. No
62. Will you foster an animal that needs socialization?

    1. Yes
    2. No
64. Fostering Preferences

    1. Cat

    1. Kitten

    1. Dog

    1. Puppy
66. Other Preferences for Fostering:
68. What are your work hours (if you work outside the home)?
69. Where will the animal be kept when you are not at home?
70. Where will the animal be kept in the day?
71. Where will the animal be kept at night?
73. Do you have a fully fenced yard?

    1. Yes
    2. No
74. Type and height of fence:
75. Do you have the time to offer these needy animals the extra attention and love required for their adjustment prior to adoption?

    1. Yes
    2. No
77. Any other comments or questions?
79. By agreeing to foster, you provide temporary care in your home for companion animals who are not ready to be placed in adoption or when the shelter is full. Some animals only need a home for a few days, others may need to be housed for months. By offering your time, energy, love and home to an animal in need, you help prepare the animal for adoption into a permanent home, as well as prevent overcrowding at the shelter. Your interest in participating in our program is greatly appreciated. By entering your name below, you acknowledge that the information provided on this application is correct to the best of your knowledge.
81. Full Name
82. Date
Leave This Blank:


84. 1. Receive an email copy of this form.
85. Email address

    This field is not part of the form submission.

86. Submit

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