Foster Application Template

Coal Mountain Animal Rescue INC

754 Bear Creek Street, Auburn Pa 17922

*** INCOMPLETE APPLICATIONS WILL NOT BE APPROVED ***

Please fill out the application completely. In order to ensure that a particular animal is the right choice for your household, we must have an understanding of your needs and expectations with regard to acquiring a new pet. All references will be checked so please provode phone numbers, and let them know we will be calling.

***YOU MUST BE 21 YRS OF AGE OR OLDER TO ADOPT AN ANIMAL FROM OUR ORGANIZATION***

Adoption Fees are determined on a case-by-case basis in consideration of the pet's age, any medical conditions, vetting that has already been provided vs. procedures yet to be completed or future care required, etc. In most cases, all age-appropriate vaccinations as well as spay/neuter is provided unless there are extenuating circumstances. Fees include health certificate to travel, transport fee, and other fees associated with the adoption. Adoption fees are subject to change, we will make every effort to relay the changes due to the rise in prices.

Fees are payable via PayPal, Venmo, CashApp, credit card or arrangements can be made to pay by cash.

All adoption fees are *Non-refundable* and by completion of this agreement you are acknowledging your understanding agreement of this.

How did you hear about Coal Mountain Animal Rescue

Which dog are you interested in?*

Full Name*

First NameLast Name

Age

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number - Cellular*

Area CodePhone Number

Phone Number - Work

Area CodePhone Number

What is your profession?

Do you live in a:

Do you:*

OwnRentLive with ParentsOther

If Renting: Please indicate landlord contact information*

Household Setting

RuralSuburbanUrban

Describe your Homes Activity Level

Busy/NoisyModerate Comings/GoingsQuiet with Occasional Guests

Please List all People Living in the Household (Include Name, Relationship, Gender and Age)*

Does Anyone in your Household have Allergies to Animals?*

YesNo

Are all members of your Family agreeable to adopting/fostering a Dog?*

YesNo

Please List any Pets you have Living (Please include Name, Breed, Age, Altered, Sex, UTD Vaccines, Heartworm, Living/Deceased)*

Do you have a preference in the sex of the dog?

MaleFemaleNo Preference

Are you willing to do a foster to adopt trial for 30 days?*

YesNo

What age are you looking for?

What size dog are you willing to adopt (Check all that apply)

SmallMediumLarge

Please describe the type of dog you are willing to adopt (Please include breed, coat length, personality traits, energy level, hypoallergenic) We always want to make sure we have the best fit for our adopter's homes.

If you're interested in the 30 day foster to adopt, are you willing to take the dog to any vet appts*

YesNo

if yes to above^^ Do you drive or have access to a vehicle to bring your foster to adopt to appointments

YesNo

If No please explain

Are you willing and able to medicate your adoptive dog even if it just a monthly heartworm preventative?*

YesNo

We cannot guarantee a dog to be housebroken, are you equipped to train with love and patience?*

YesNo

Have you had any experience with with an emotionally or physically neglected or abused dog?*

YesNo

If Yes please explain

Are you willing to use a crate for a dog if recommended?*

YesNo

Do you have a fenced yard?*

YesNoPartial

If fenced, please give details on height, material, # of gates, are gates locked or lockable?

How many hours in a day would the foster/adopted dog be left alone?*

What are your plans to exercise your adopted dog? Please list any parks near by or trails, how many walks a day, approximate length, and activities such as agility.*

Please list 3 personal references with names, addresses, phone numbers and how related. We prefer it not to be all relatives. Are you ok with this?*

YesNo

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Vet Reference: Full Name/ Vet Office name*

First NameLast Name

Phone Number

Area CodePhone Number

Reference #1: Full Name*

First NameLast Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

Reference #2: Full Name*

First NameLast Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

Reference #3: Full Name

First NameLast Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any Coal Mountain Animal Rescue Inc animal fostered/adopted by me.

I certify that the above information is correct, and I understand that the information will be verified.

I understand that by submitting this form electronically, I agree to release and covenant to hold harmless Coal Mountain Animal Rescue Inc. and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the foster/adopted dog.

I accept full responsibility for the dog(s) actions at all times, and release Coal Mountain Animal Rescue Inc. from any liabilities or damages that may be incurred because of fostering/adopting such dog(s).

I agree to have Coal Mountain Animal Rescue Inc. complete reference call checks and conduct a home visit inspection to be able to approve my foster/adoption application.

I agree that if I'm unable to foster/adopt the dog(s) anymore that I will return the dog(s) to Coal Mountain Animal Rescue Inc.and try to give Coal Mountain Animal Rescue Inc. a 2 week period to try and find another suitable foster /adopter for the dog(s).

Coal Mountain Animal Rescue Inc. can not guarantee a dog will be kid, cat, or dog friendly. We can not guarantee that the foster/adopted dog won't have any behavior issues or has been behavior tested.

Date

MonthDayYear

Please type your full name below which will serve as your electronic signature:*