Revive Hearts Foster Application

Foster Application
Why do you want to foster? *
First & Second Choices
What would your Foster Preference be? (Check all that apply)*

FemaleMaleEither Male/FemaleYoungerOlderAny age
Check each option that you are interested in.*

Long term fosterAll year around fosterShort term fosterSeasonal fosterGet Pre-ApprovedEmergency placement foster
Are you willing to work with us to correct any possible behavior issues that the rescue may have?

YesNoTo a pointYes, Short term
Do you have a trainer that you would use if needed? Yes / No (If Yes / Provide Information)
Foster Personal Information
Name*

First NameLast Name
Date of Birth? *
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Work Phone; *

Area CodePhone Number
Contact Number*

Area CodePhone Number
Yourself & Family
Please fill out the entire application. All questions marked with a ( * ) are required and they must be answered. If they are not, the application will not submit. If any of those marked required do not pertain to you, mark (N/A) in order to move forward with the application process.
List the Names & Ages of any additional (Adult) family members or those who live in your home. *
List the Names & Ages and Relationship to you of any Children under the age of #18 who live with you or who visit your home on a regular basis. *
List the Employers, Occupations & Hours of Everyone who lives in your home? *
Home Environment
Do you Own or Rent your home?*

OwnRentOther
Choose which best describes your living situation.*

HouseCondoApartmentModular Home
If a Rental, does your lease permit you to have animals?*

YESNOYES/ LIMITED
If living in an apartment / condo are there any restrictions on dog ownership or Breed? (Explain)*
Landlords Name;

First NameLast Name
Landlord's Phone #

Area CodePhone Number
Do you have a yard with a fenced in yard?*

YESNO
If Yes, Please describe in detail including the Type & Height of fence and any Security measures taken to prevent animals from escaping or being harmed by predictors.*
Please be specific with your description.
IF No, Please describe how you plan to exercise the rescue ?
Rescue Animal Living Space & Care

This is important information, Please be Specific.
How many hours per day will your Rescue be left alone?*

1 -22 -44 -66 - 88 - moreNone
Please describe in Detail what the Rescues living situation will be. (Please give a detailed description including hours when no one will be home.)*
Please be very Specific with your answer .
Current & Previous Pets

Including Vet Care
Have you had rescues previously?*

YesNo
If Yes, name, ages, breed? Describe: Where you got them, where they are now and if re homed why? *
Please be specific
Other animals living in your home? (Click all that apply)*

DogsCatsCaged AnimalsNone
Are your pets currently UTD on Vaccinations?*

YesNoSome not All
Are your pets on Heart-worm Preventative?*

YesNoNot right nowThey will be
Are your pets Spayed or Neutered?*

YesNoNot YetSome not All
List ALL family Pets/ Include the Following: (Type / Breed / Age / Dates of last Vet. appointment & Vaccinations, Heart-worm, Flea meds. & Spay/Neuter dates) *
Have any of your pets Ever displayed any Food or other aggression's toward other animals or humans?*

YesNo
If so, Please give a detailed description. (Include: Date of any bite incidents) *
List all Previous pets that you've owned in the past 5 yrs. (Include: Years owned & where they are now. *
Vets & Personal References
Name & Address of Current Vet*

Name

Street Address Line

CityState

Zip Code
Phone Number

Area CodePhone Number
Fax Number

Area CodePhone Number
Name & Address of Previous Vet

Name

Street Address Line

CityState

Zip Code
Phone Number

Area CodePhone Number
Fax Number

Area CodePhone Number
Name & Address of Groomer

Name

Street Address Line

CityState

Zip Code
Phone Number

Area CodePhone Number
Provide 3 personal References including at least 1 person who lives with you. (Include: How they know you).*
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By signing via electronicly I agree that the information that I have provided in this application is complete and correct. I understand that any false information I have provided will invalidate this and any future applications. I further declare that I am financially and physically able to care for a rescue animal. I understand that proper food will be provided and I am able and willing to meet the needs of my rescue animal. I understand and agree to inform Revive Hearts rescue of anything that may be going on with Rescue (medical, behavior, ran away etc) I understand the requirements and grant permission for Home Checks at random, both prior to and following adoption. I submit that if a Home Check reveals falsification or misrepresentation of any facts on my part, Revive Hearts Rescue reserves the right to either refuse fostering and reclaim said rescue from premises. I release Revive Hearts Rescue from any liabilities I may incur from the fostering process or by the rescue while in my care.
Please sign below: *

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Foster Application

Foster Personal Information

Yourself & Family

Home Environment

Rescue Animal Living Space & Care

Current & Previous Pets

Vets & Personal References

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