Secondhand Snoots Rescue Inc.

Secondhand Snoots Holiday Home Application

Secondhand Snoots Rescue Inc., NFP Foster Home Application 501(c)(3) charitable organization; Illinois Department of Agriculture License #14085 PO Box 7798 | Gurnee, IL 60031 | info@secondhandsnoots,org
Which animal are you applying to be a Holiday Home for?

GraciePatchesRooster CogburnShugg
Applicant's Full Name*

First NameLast Name
Co-Applicant's Full Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number (Primary)*

Area CodePhone Number
Phone Number (Other)

Area CodePhone Number
By becoming a foster home for Secondhand Snoots you agree to regularly monitor this email address and further agree to provide us with timely responses to our emails? You may need to monitor your email's spam folder for emails from our organization.
E-mail*
Co-Applicant's E-mail
Applicant's Employer and Occupation:*
Co-Applicant's Employer and Occupation:
Would fostering this animal violate any local ordinances or laws?r*

YesNoUnknown
If yes, what is the law/ordinance or what is the web address it is listed on?
Do you live in a:*
If other, please specify
If you reside in a rental unit or condo, do you have permission from the landlord or association to have a pet?

YesNo
Name/number of landlord or condo association:
Are you able to commit to fostering the dog for a minimum of 8-weeks? (Your foster time can be extended at the beginning or the end of the 8-weeks if you are interested and able.)*

YesNoMaybe
Do you have a yard?*

Yes - No fenceYes - Fenced inYes - Partially fencedNo yard
If yes, what type fence and how tall?
Do you have a pool?*

YesNo
If yes, is it fenced or covered

Yes - FencedYes - CoveredYes - Both fence and coveredNo Fence or cover
Are there children living at your residence?*

YesNo
If yes, how many, and what are their ages; please note full or part time:
Does anybody living in the home have allergies to animals?*

YesNo
If yes, please explain.
Where will your foster animal be kept during the day?*
Where will your foster animal be kept while everybody is home?*
Where will your foster animal be kept at night?*
How many hours will the foster animal(s) be home alone during a typical day?*
If you have other pets, please list their name(s) and their species/ breeds/ages (please enter "none" if you do not have any other pets):
Are they spayed/neutered, and up to date on vaccinations?

YesNo
If no, please explain:
Do you currently have any animals with special medical needs?

YesNo
If yes, please describe
Why do you want to foster for Secondhand Snoots?*
Please list your size and temperament requirements for a foster animal..*
Please list any qualities in an animal that would not suit your home.*
Have you ever had an animal put to sleep?*

YesNo
If yes, please explain.
Have you ever returned an animal to a rescue or dropped an animal off at animal control?*

YesNo
If yes, please explain.
Veterinary Reference

NOTE: Please notify your veterinarian’s office that we will be calling for a reference and that you give your permission to release information to us regarding the care of your personal companion animals.
Veterinary Reference #1: Name of Veterinarian / Office:
Office Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Vet's Phone Number

Area CodePhone Number
Name of Animals treated at this office:
Veterinary Reference #2: Name of Veterinarian / Office:
Office Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Vet's Phone Number

Area CodePhone Number
Name of Animals treated at this office:
Personal References:

In addition to veterinary reference, all applicants must have 2 (two) personal references checks completed prior to being scheduled for a home visit for any animal through Secondhand Snoots Rescue Inc., NFP. Please supply contact information for at least 2 (two) people who have known you for at least one year, who do not live with you, and can personally attest to how you care for your own companion animal(s) or have cared for their companion animal(s). If you have volunteered for or worked with a shelter, animal control or another rescue please supply that information as one of your references.
Reference #1:
Reference 1 -Full Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Reference #2:
Reference 2 -Full Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Additional Reference: (not required)
Reference 3 - Full Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
- You understand that you are applying for a temporary foster arraingment to last from November 22, 2013 until January 17, 2014. If approved, an extention in time can be discussed at any time during the fostering process.
- It is the policy of Secondhand Snoots Rescue Inc., NFP to perform a home visit prior to foster placement. We will contact you after completing all of your reference checks to set one up.
- We will also work with you to set up a meet-and-greet for your potential holiday home foster with you, your family members and any existing pets you may have.
- Placement of any animal into any home is at the sole descretion of Secondhand Snoots Rescue, NFP and it's Board of Directors.
- Secondhand Snoots Rescue Inc., NFP reserves the right to refuse any application / prospective foster home applicant.
Date:

MonthDayYearHourMinutesAM/PM Option
Electronic Signature - Please type you full name*
By giving your signature you attest that all information above is true and correct and that you give permission to Secondhand Snoots Rescue Inc., NFP to check your references which may require disclosure of information that you have provided in this application or that you have given via email or conversation to the people you have listed as references, including, but not limited to your landlord/condo association and veterinary office.
Should be Empty:

Secondhand Snoots Holiday Home Application

Veterinary Reference

Personal References:

Reference #1:

Reference #2:

Additional Reference: (not required)