Harmony Retreat & Animal Rescue Foster Application Form

How did you hear about Harmony Retreat & Animal Rescue?*

Full Name*

First NameLast Name

Age (must be at least 25)*

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Preferred Phone Number - *

Area CodePhone Number

Do you live in a:*

OwnRentLive with ParentsOther

If Renting: Please indicate landlord contact information

If Renting: Do you already have written permission from your landlord to have the type of animal you are interested in fostering?

Busy/NoisyModerate Comings/GoingsQuiet with Occasional Guests

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

YesNo

Yes, indoorsYes, outdoors onlyNo

Who will be responsible for the animal?

YesNo

Please List any Pets you have Living or Deceased (Please include Name, Breed, Age, Living/Deceased)*

MaleFemaleNo Preference

YesNo

If not, what age would you consider?

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.*

YesNo

If No please explain

YesNo

If Yes please explain

YesNo

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?*

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

YesNo

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 HARMONY RETREAT & ANIMAL RESCUE 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 HARMONY RETREAT AND ANIMAL RESCUE 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 HARMONY RETREAT AND ANIMAL RESCUE from any liabilities or damages that may be incurred because of fostering such animals.

I agree to have HARMONY RETREAT AND ANIMAL RESCUE 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 HARMONY RETREAT AND ANIMAL RESCUE and try to give HARMONY RETREAT AND ANIMAL RESCUE a 2 week period to try and find another suitable foster.

Date*

MonthDayYear

Your name*