Pre-Foster Application form

How did you hear about Little Beans Orphan Ark Rescue?
Full Name *

First Name Last Name
Age
E-mail *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number - Home

Area Code Phone Number
Phone Number - Cellular

Area Code Phone Number
Phone Number - Work

Area Code Phone Number
Do you live in a:
Do you:

Own Rent Live with Parents Other
If Renting: Please indicate landlord contact information
Household Setting

Rural Suburban Urban
Describe your Homes Activity Level

Busy/Noisy Moderate Comings/Goings Quiet 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?

Yes No
Are all members of your Family agreeable to Fostering a Dog or Cat?

Yes No
Please List any Pets you have Living or Deceased (Please include Name, Breed, Age, Altered, Sex, UTD Vaccines, Heartworm, Living/Deceased) *
Do you have a preference in sex of foster?

Male Female No Preference
Are you willing to foster a dog or cat of any age?

Yes No
If not, what age would you consider?
What size dog are you willing to foster? (Check all that apply)

Small Medium Large
Please describe the type of dog you are willing to foster (Please include breed, coat length, personality traits, energy level, hypoallergenic) We always want to make sure we have the best fit for our foster homes.
Are you willing to take your foster dog or cat to vet appointments at a convenient time for you?

Yes No
Do you drive or have access to a vehicle to bring your foster to events and appointments

Yes No
If No please explain
Are you willing and able to medicate your foster, even if it just a monthly heartworm preventative?

Yes No
We cannot guarantee a dog or cat to be housebroken, are you equipped to train with love and patience?

Yes No
Have you had any experience with with an emotionally or physically neglected or abused dog?

Yes No
If Yes please explain
Are you willing to use a crate for a dog if recommended?

Yes No
Do you have a fenced yard?

Yes No Partial
If fenced, please give details on height, material, # of gates, are gates locked or lockable?
How many hours in a day would the foster be left alone?
What are you plans to exercise your foster? 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?

Yes No
Vet Reference: Full Name *

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
Reference #1: Full Name *

First Name Last Name
Relation to applicant(s):
E-mail
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
Reference #2: Full Name *

First Name Last Name
Relation to applicant(s):
E-mail
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
Reference #3: Full Name

First Name Last Name
Relation to applicant(s):
E-mail
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
Date

Month Day Year
Your name *
E-mail
Signature *

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