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 - Main

Phone Number - Secondary

Do you live in a:

Do you:

OwnRentLive with ParentsOther

If Renting: Please indicate landlord contact information

Describe your Homes Activity Level

Busy/NoisyModerate Comings/GoingsQuiet with Occasional Guests

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

Does Anyone in your Household have Allergies to Animals?

YesNo

Are all members of your family agreeable to fostering an animal?

YesNo

Please list any pets you have (Please include Name, Breed, Age, Altered, Sex, UTD Vaccines)*

Do you have a preference in sex of foster?

MaleFemaleNo Preference

Are you willing to foster an animal of any age?

YesNo

If not, what age would you consider?

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

Are you willing to take your foster dog 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 heartworm preventative?

YesNo

We cannot guarantee an animal to be housebroken/litter trained, are you equipped to train with love and patience?

YesNo

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

YesNo

If Yes please explain

How many hours in a day would the foster be left alone?

Vet Reference: *

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

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Reference #2: Full Name*

First NameLast Name

Relation to applicant(s):

E-mail

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Reference #3: Full Name

First NameLast Name

Relation to applicant(s):

E-mail

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

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 JEEPIN FOR PAWS 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 JEEPIN FOR PAWS and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the foster animal.

I accept full responsibility for the animal(s) actions at all times, and release JEEPIN FOR PAWS from any liabilities or damages that may be incurred because of fostering such dog(s).

I agree to have JEEPIN FOR PAWS 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 animal(s) anymore that I will return the animal(s) to JEEPIN FOR PAWS and try to give JEEPIN FOR PAWS a 1 week period to try and find another suitable foster for the animal(s).

Date

MonthDayYear

Your name*

E-mail

example@example.com

FOSTER APPLICATION