Foster Application Form

Full Name*

First NameLast Name

Age

E-mail*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number - Home

Phone Number - Cellular*

Phone Number - Work*

Do you live in a:

Do you:*

OwnRentLive with ParentsOther

If Renting: Please indicate landlord contact information*

If Renting, please give us your Landlord’s Phone Number *

Please enter a valid phone number.

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 Fostering a Dog or Cat?*

YesNo

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

Are you willing to take your foster to vet appointments at a convenient time for you?*

YesNo

Do you drive or have access to a vehicle to bring your foster to events and appointments*

YesNo

If No please explain

Are you willing and able to medicate your foster, even if it just a monthly flea/tick preventative?*

YesNo

Dog Fosters: 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 or cat?*

YesNo

If Yes please explain

Dog Fosters: Are you willing to use a crate for a dog if recommended?

YesNo

Dog Fosters: 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 be left alone?*

Dog Fosters: 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.

Would you be willing to work with a trainer and/or behaviorist to help your foster dog or cat become more adoptable?*

YesNo

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

Vet Reference: Full Name*

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Reference #1: Full Name*

First NameLast Name

Relation to applicant(s):*

E-mail

example@example.com

Phone Number*

Reference #2: Full Name*

First NameLast Name

Relation to applicant(s): *

E-mail

example@example.com

Phone Number*

Reference #3: Full Name*

First NameLast Name

Relation to applicant(s):*

E-mail

example@example.com

Phone 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 Familiar Heart Animal Society animal fostered 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 Familiar Hearts Animal Society and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the foster pet. I accept full responsibility for the pet(s) actions at all times, and release Familiar Hearts Animal Society from any liabilities or damages that may be incurred because of fostering such pet(s). I agree to have Familiar Hearts Animal Society complete reference call checks and conduct a home visit inspection to be able to approve my foster application. I agree that if I'm unable to foster the pet(s) anymore that I will return the pet(s) to Familiar Hearts Animal Society and give a 2 week period to try and find another suitable foster for the pet(s).

Date

MonthDayYear

Your name*

E-mail*

example@example.com