Foster Application Form

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

Do you:

Describe your Homes Activity Level (This just helps with placement)

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

Does Anyone in your Household have Allergies to Animals?

Are all members of your Family agreeable to Fostering?

Please List any Pets you have currently (Please include Name, Species, Age, Altered, Sex, UTD Vaccines)

Do you have a preference in sex of foster?

Choose all that you are willing to foster (You can change your mind at anytime)

Do you drive or have access to a vehicle to bring your foster to and from shelter when needed?

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

Vet Reference: Full Name

First NameLast Name

Address of Vet

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number of Vet

Area CodePhone Number

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I understand that by applying I can get called when a kitten/s enter the shelter. I scan still say not at this time.

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 Pointe Coupee Parish Animal Services and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the foster Kitten.

I agree that if I'm unable to foster the Kitten(s) anymore that I will return the dog(s) to PCPAS and try to give PCPAS a 1 week period to try and find another suitable foster for the Kitten(s).

Date

MonthDayYear

Signature

Pointe Coupee Animal Services