Temporary Care Application Project Home Away From Home 1.3.22

  • Project Home Away from Home Temporary Care Application

    Please set aside 15 minutes to complete the form in its entirety.

  • Are you currently experiencing a crisis (i.e. eviction or loss of housing, emergency or long-term medical or behavioral health hospitalization, seeking safety from domestic violence, short-term injury or illness that you need to seek treatment for), then we may have a program that can help you! The Arizona Humane Society's Project Home Away From Home allows individuals experiencing crisis to have their pet temporarily cared for (typically 30-90 days). 

    Once received, AHS will review your application and determine if you are a good candidate for the program. If shelter capacity allows, we will reach out to schedule a medical and behavioral evaluation for your pet. If we are unable to bring your pet in for evaluation and you are still in need of help, a new application may be needed if more than 30 days have passed. Please be advised if you do not qualify for Project Home Away From Home, you will be notified via email. Thank you for your understanding.

  • Today's Date*
     - -
  • Format: (000) 000-0000.
  • Have you used the Project Home Away From Home program in the past?*
  • Where you referred to the Arizona Humane Society by another agency or program?*

  • Owner Demographics

  • Primary Language*
  • Current Housing Situation*
  • Are you currently in a shelter program (homeless, domestic violence, other) or seeking entry into a shelter program?*
  • Employment Status*
  • What is your yearly household income?*
  • Are you currently receiving assistance from any of the following?*

  • REASON FOR NEED

  • Are you currently participating in crisis related support services or receiving support from an outside agency to resolve your current situation?*
  • How many days are you in need of Temporary Care for your pet?*

  • Program Requirements

  • Are you the legal owner of the pet(s) in need of placement? We require for the owner to sign documentation for temporary placement.*
  • Will the owner be available to sign documentation for the temporary care program?*
  • The animal is required to under go an in person behavior and medical evaluation in order to be accepted into the program. Will the owner be able to bring the pet(s) in? (Please note that we are located at 55th Street and Van Buren in Phoenix, Arizona. We are unable to transport or pick up the animal on behalf of the owner.)*
  • Current vaccinations (Rabies, DA2PP/FVRCP, Bordetella) are a requirement for your pet(s) to be accepted into the program. My pet has received the following vaccinations in the last 12 months:*
  • If your pet is not vaccinated, are you willing to have AHS vaccinate your pet?*
  • Being spayed/neutered is a requirement for your pet(s) to be accepted into the program. If your pet is not spayed/neutered, are you willing to have AHS spay/neuter your pet?*
  • If your pet(s) are able to be accepted into this program, are you able to house them until a foster home is found? (Average length of time to find foster is 2-7 days.)*
  • This program requires you to have weekly contact to update our Community Support Coordinator about your progress toward resolving your circumstances. Are you able and willing to keep in contact with AHS in regards to your situation?*
  • Format: (000) 000-0000.
  • There is no set cost to be accepted into the program, AHS asks that if you are able to make a donation or help provide food for your animal, that you do so. Would you be able to make a donation or help provide food or other supplies for your animal?*

  • Animal Information

  • This application can accomodate up to 2 dogs and 3 cats. If you are in need of assistance for more than 2 pets of one species, please indicate below. Someone from AHS will follow up with you to receive the Pet Profile information on your additional pets. 

    • ERROR Start 

    • It appears there may be an error! 

      You selected that you are not in need of assistance for any cats or dogs. Unfortunately, the Project Home Away from Home is only for cats and dogs. If you need assistance with a pet that is not a cat or dog, please contact our Pet Resource Center (602-997-7585 ext 20755). Otherwise please go back and select at least 1 for cat or dog. 

      To Exit push Submit Below. 

    • ERROR End 
    • Dog 1- Start of Section 

    • DOG ONE INFORMATION

    • Dog 1- End of Section 
    • Dog 2 - Start of Section 

    • DOG TWO INFORMATION

    • Dog 2- End of Section 
    • Cat 1- Start of Section 

    • CAT ONE INFORMATION

    • Cat 1- End of Section 
    • Cat 2- Start of Section 

    • CAT TWO INFORMATION

    • Cat 2- End of Section 
    • Cat 3 - Start of Section 

    • CAT THREE INFORMATION

    • Cat 3- End of Section 
    • Additional Pets - START 

    • You selected that you need assistance with more than 2 dogs and/or 3 cats. Please provide the information below for the additional pets and we will be in contact with instructions on how to fill out pet profiles for these additional pets.

      Please list the following for each additional pet not already listed on the application:

    • Additional Pets- End of Section 
    • Option to Proceed START 

    • Thank you for providing this information for your pet(s). The next step is to complete a Pet Profile(s) in the next section.

      Unfortunately, not every pet is a candidate for temporary care due to the health and safety of your pet, as well as our staff and volunteers. Pets with chronic illnesses or behavior concerns that cannot be managed safely in the shelter or foster care will not be accepted into the program.

      If we have concerns or additional questions about your pet's health and behavior, we will reach out to speak further about your pet's behavioral and/or medical needs to determine if we will safely be able to care for your pet.

      An In-Person behavior and medical evaluation is required for all pets before being accepted into the program.  

    • Pet profiles are required to be considered in the program, would you like to continue on to complete the Pet Profiles, for your pets to be considered for the Temporary Care Program?*
    • Option to Proceed End 
    • Pet Profile - START Dog/Puppy #1 

    • DOG ONE PROFILE

    • Behavior History

    • Has this dog ever bitten a person?*
    • What were the extent of the injuries?*
    • Has the dog ever been in a fight with another dog?*
    • What were the extent of the injuries?*

    • Medical History

    • Has this dog been seen by a veterinarian?*
    • When was this dog last seen by a veterinarian?*
       - -
    • Has your dog ever required a special surgery?*
    • Has this dog been diagnosed or treated for any of the following medical condition(s)? (Check all that apply)*
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    • Is this dog on any medications?*
    • Is this dog on Fluoxetine, Prozac, Trazodone, or Gabapentin?*
    • Does this dog have any urgent medical needs?*
    • If applicable, does this dog have to be muzzled at the veterinarian or groomer?

    • General Behavior

    • Has this dog ever met any unfamiliar dogs?*
    • Has this dog ever been walked on a leash?*
    • Rows
    • Rows
    • Is this dog afraid of anything?*
    • Has this dog escaped your property one or more times in the last six months?*

    • Homelife

    • This dog has lived with: (Check all that apply)*
    • Has this dog lived with: (Check all that apply)*
    • When left alone, does this dog usually show any of the following behaviors? (Check all that apply)*
    • Is the dog allowed on furniture?*
    • This dog does the following while riding in a car:*
    • What commands does this dog know? (Check all that apply)*
    • Does this dog know any special tricks?*
    • This dog's energy level is best described as:*
    • When this dog plays, do they typically do any of the following? (Check all that apply)*
    • What toys does this dog like? (Check all that apply)*
    • What games does this dog like? (Check all that apply)*
    • Has this dog attended any obedience or training classes?*
    • Do you feed this dog people food?*
    • Dog/Puppy Profile 1 - END 
    • Dog/Puppy Profile 2 - START 

    • DOG TWO PROFILE

    • Behavior History

    • Has this dog ever bitten a person?*
    • What were the extent of the One to four punctures from a single bite with bruisinginjuries?*
    • Has the dog ever been in a fight with another dog?*
    • What were the extent of the injuries?*

    • Medical History

    • Has this dog been seen by a veterinarian?*
    • When was this dog last seen by a veterinarian?*
       - -
    • Has this dog been diagnosed or treated for any of the following medical condition(s)? (Check all that apply)*
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    • Is this dog on any medications?*
    • Is this dog on Fluoxetine, Prozac, Trazodone, or Gabapentin?*
    • Has your dog ever required a special surgery?*
    • Does this dog have any urgent medical needs?*
    • If applicable, does this dog have to be muzzled at the veterinarian or groomer?

    • General Behavior

    • Has this dog ever met any unfamiliar dogs?*
    • Has this dog ever been walked on a leash?*
    • Rows
    • Rows
    • Is this dog afraid of anything?*
    • Has this dog escaped your property one or more times in the last six months?*

    • Homelife

    • This dog has lived with: (Check all that apply)*
    • Has this dog lived with: (Check all that apply)*
    • When left alone, does this dog usually show any of the following behaviors? (Check all that apply)*
    • Is the dog allowed on furniture?*
    • This dog does the following while riding in a car:*
    • What commands does this dog know? (Check all that apply)*
    • Does this dog know any special tricks?*
    • This dog's energy level is best described as:*
    • When this dog plays, do they typically do any of the following? (Check all that apply)*
    • What toys does this dog like? (Check all that apply)*
    • What games does this dog like? (Check all that apply)*
    • Has this dog attended any obedience or training classes?*
    • Do you feed this dog people food?*
    • Dog/Puppy Profile 2 - End 
    • Pet Profile - START Cat #1 

    • CAT ONE PROFILE

    • Behavior History

    • Has this cat bitten anyone?*
    • When did the last bite occur?*
       - -
    • How did the bite end?*
    • If biting is an ongoing behavior, when did it begin?*
    • How often do the bites break skin?*
    • What warning signs does this cat display before the bite?*

    • Litter Box History

      Challenges surrounding litter box usage is one of the main reasons cats are surrendered. Please help us by giving as much detailed and accurate information as possible.
    • Does this cat have litter box issues?*
    • What are the issues? (Check all that apply)*
    • When did this begin?*
    • Has this cat been to a veterinarian to rule out a health issue?*

    • Household History

    • How would you best describe this cat? (Click all that apply)*
    • Rows
    • If other pets are living in your home, does this cat get along with them?*
    • Does this cat display any destructive behavior? (Click all that apply)*
    • Does this cat groom/lick their fur to the point where there are bald patches or thinning?*
    • Is this cat afraid of anything?*
    • Does this cat have any experience being outside?*
    • Has this cat ever escaped or tied to escape from your house?*

    • Hiding History

    • How often does this cat hide?*
    • Does this cat hide when new people are around?*
    • When you try to interact with this cat while it is hiding does it hiss, growl, or show any fearful behavior?*
    • When hiding, is this cat still eating, drinking and using the litter box?*
    • Does this cat seek any attention when they are not hiding?*

    • Medical History

    • Has this cat been seen by a veterinarian?*
    • When was this cat last seen by a veterinarian?*
       - -
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    • Has this cat ever required a special surgery?*
    • Has this cat been diagnosed or treated for any of the following medical condition(s)? (Check all that apply)*
    • Is this cat on any medications?*
    • Is this cat on Fluoxetine or Paroxetine?*
    • Is this cat declawed?*
    • Cat Profile 1 - END 
    • Cat Profile 2 - START 

    • CAT TWO PROFILE

    • Behavior History

    • Has this cat bitten anyone?*
    • When did the last bite occur?*
       - -
    • How did the bite end?*
    • If biting is an ongoing behavior, when did it begin?*
    • How often do the bites break skin?*
    • What warning signs does this cat display before the bite?*

    • Litter Box History

      Challenges surrounding litter box usage is one of the main reasons cats are surrendered. Please help us by giving as much detailed and accurate information as possible.
    • Does this cat have litter box issues?*
    • What are the issues? (Check all that apply)*
    • When did this begin?*
    • Has this cat been to a veterinarian to rule out a health issue?*

    • Household History

    • How would you best describe this cat? (Click all that apply)*
    • Rows
    • If other pets are living in your home, does this cat get along with them?*
    • Does this cat display any destructive behavior? (Click all that apply)*
    • Does this cat groom/lick their fur to the point where there are bald patches or thinning?*
    • Is this cat afraid of anything?*
    • Does this cat have any experience being outside?*
    • Has this cat ever escaped or tied to escape from your house?*

    • Hiding History

    • How often does this cat hide?*
    • Does this cat hide when new people are around?*
    • When you try to interact with this cat while it is hiding does it hiss, growl, or show any fearful behavior?*
    • When hiding, is this cat still eating, drinking and using the litter box?*
    • Does this cat seek any attention when they are not hiding?*

    • Medical History

    • Has this cat been seen by a veterinarian?*
    • When was this cat last seen by a veterinarian?*
       - -
    • Browse Files
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    • Has this cat ever required a special surgery?*
    • Has this cat been diagnosed or treated for any of the following medical condition(s)? (Check all that apply)*
    • Is this cat on any medications?*
    • Is this cat on Fluoxetine or Paroxetine?*
    • Is this cat declawed?*
    • Cat Profile 2 - END 
    • Cat Profile 3 - START 

    • CAT THREE PROFILE

    • Behavior History

    • Has this cat bitten anyone?*
    • When did the last bite occur?*
       - -
    • How did the bite end?*
    • If biting is an ongoing behavior, when did it begin?*
    • How often do the bites break skin?*
    • What warning signs does this cat display before the bite?*

    • Litter Box History

      Challenges surrounding litter box usage is one of the main reasons cats are surrendered. Please help us by giving as much detailed and accurate information as possible.
    • Does this cat have litter box issues?*
    • What are the issues? (Check all that apply)*
    • When did this begin?*
    • Has this cat been to a veterinarian to rule out a health issue?*

    • Household History

    • How would you best describe this cat? (Click all that apply)*
    • Rows
    • If other pets are living in your home, does this cat get along with them?*
    • Does this cat display any destructive behavior? (Click all that apply)*
    • Does this cat groom/lick their fur to the point where there are bald patches or thinning?*
    • Is this cat afraid of anything?*
    • Does this cat have any experience being outside?*
    • Has this cat ever escaped or tied to escape from your house?*

    • Hiding History

    • How often does this cat hide?*
    • Does this cat hide when new people are around?*
    • When you try to interact with this cat while it is hiding does it hiss, growl, or show any fearful behavior?*
    • When hiding, is this cat still eating, drinking and using the litter box?*
    • Does this cat seek any attention when they are not hiding?*

    • Medical History

    • Has this cat been seen by a veterinarian?*
    • When was this cat last seen by a veterinarian?*
       - -
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Has this cat ever required a special surgery?*
    • Has this cat been diagnosed or treated for any of the following medical condition(s)? (Check all that apply)*
    • Is this cat on any medications?*
    • Is this cat on Fluoxetine or Paroxetine?*
    • Is this cat declawed?*
    • Cat Profile 3 - End 

  • Thank you for applying to the Arizona Humane Society’s Project Home Away from Home. We understand that crisis often leaves individuals having to make a difficult decision between seeking assistance and keeping their pet. While the Arizona Humane Society’s focus is to help Maricopa County homeless pets, we also know that helping those pets that have homes and loving families is essential in the fight to end pet homelessness.

    We would like to help every pet and pet owner; however, we also have to ensure that we have the capacity and ability to keep our staff, volunteers and your pets safe and well cared for. This is why we have a diligent screening process. Unfortunately, we cannot accept every pet due to space limitations in the shelter and foster homes, underlying medical concerns for the pet or behavioral concerns. 

    Once your application is reviewed and all important information is received and if there is space in our program, our Community Support Coordinator will contact you to schedule an appointment to evaluate your pet(s)’ behavior with people and animals as well as a medical evaluation. We understand that crisis situations often lead to the need to have a solution quickly, and we will attempt to accommodate you and provide solution resources as soon as possible. 

    If you are in need of more than 2 dogs and/or 3 cats, we will be in touch with instructions for how to provide pet profiles for the additonal pets.

    Please communicate any needs you have and we will do our best to accommodate and advise participation in this program is one-time only.

     

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