Foster Application Form

How did you hear about us?

Full Name*

First NameLast Name

Age

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number - Home

Area CodePhone Number

Phone Number - Cellular

Area CodePhone Number

Phone Number - Work

Area CodePhone Number

Do you live in a:

Do you:

OwnRentLive with ParentsOther

If Renting: Please indicate landlord contact information

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?

YesNo

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

Do you have a preference in sex of foster?

MaleFemaleNo Preference

Are you willing to foster a dog of any age?

YesNo

If not, what age would you consider?

What size dog are you willing to foster? (Check all that apply)

SmallMediumLarge

Please describe the type of dog you are willing to foster (Please include breed, coat length, personality traits, energy level, hypoallergenic) 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 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?

YesNo

If Yes please explain

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

YesNo

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?

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.

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

Area CodePhone Number

Reference #1: Full Name*

First NameLast Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Reference #2: Full Name*

First NameLast Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Reference #3: Full Name

First NameLast Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

By sending this electronically, I acknowledge that I have read this questionnaire thoroughly and understand it fully.

I understand that applying does not guarantee approval and that providing untruthful answers or failing to comply with the requirements of this application can result in the forfeiture of any Silicon Valley Animal Rescue animal fostered by me.

I certify that the above information is accurate, and I understand that it will be verified.

I understand that by submitting this form electronically, I agree to release and covenant to hold harmless Silicon Valley Animal Rescue and its members from any claims, damages, costs, or actions incurred as a result of the care or actions of the foster dog.

I accept full responsibility for the dog's actions at all times, and release Silicon Valley Animal Rescue from any liabilities or damages that may be incurred because of fostering such dog(s).

I agree to have Silicon Valley Animal Rescue conduct a reference call check and a home visit inspection to approve my foster application.

I agree that if I'm unable to continue fostering the dog(s), I will return the dog(s) to Silicon Valley Animal Rescue and give them 30 days to try to find another suitable foster for the dog(s).

Date

MonthDayYear

Your name*

E-mail