Application to Foster or Adopt

Application to Foster or Adopt
Which role are you applying for?

FosterAdopter
I am looking to foster ...*

DogCatEither
Which pet are you specifically interested in?
If applicable
Please indicate the type(s) of foster you would like to be:*

Finder-turned-Foster (You found a dog and are willing to foster for an indefinite period of time)Full Foster (You are available to foster a dog for East CAN long-term)Foster for a Foster (Short term. You are available to foster, but only for limited time-frames)Emergency Foster (You can house a dog for 1-3 days in an emergency situation)
What qualities are you looking for in a dog? (Please check all that apply)

ProtectionCompanionshipCompany for another petApartment livingHiking/WalkingOutdoor activitiesGift for someoneHuntingOther
What size pet are you most comfortable with?
What age range of pet are you most comfortable with?
Would you accept a special-needs animal (i.e. deaf, senior, blind, hospice care)?

YesNo
Is there a breed, size or type of dog that you absolutely will not accept?

YesNo
If yes, please describe and explain.
Contact Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Home Phone*

Area CodePhone Number
Cell Number

Area CodePhone Number
Work Number

Area CodePhone Number
Best way to reach you and when?*
Environment
Have all the adults in the household agreed to welcome this dog to your family?*

YesNo
List all people living in the household (including yourself, provide name, relationship, gender and age)*
List any pets you currently have living in your household (dog, cat, rabbit, bird, etc.) Please include name, species/breed, age, gender and where they are housed.
If applicable above, indicate which, if any of these pets are unaltered, not vaccinated or not on heartworm preventative.
Where do you currently reside?*

HouseApartmentCondoMobile HomeDuplexParents' HomeOther
How long have you lived in this residence?*
Do you Own or Rent?*

OwnRent
If you rent, list your landlord's name and contact information.
If you live in a complex or rent, does your lease or HOA allow animals?

YesNo
If restrictions apply, provide specifics (i.e. number of animals, weight limits)
Is anyone in the household allergic to pets or have asthma?*

YesNo
If known allergies or asthma exist, please elaborate.
Pet Care
Who will be responsible for caring for this dog?*
Do you as the applicant accept full responsibility for the continuous proper feeding, watering, housing and leashing of this animal?*

YesNo
How much time will the dog spend outside unsupervised?*

0 - 25%26 - 50%51 - 75%76 - 100%
How will you keep the dog confined to your property?*

FenceOther
If fenced, indicate the fence height and type. If other, please elaborate.*
Do you plan to move in the near future?*

YesNo
If yes, when are you moving and where?
If at a future time, you move to a property that does not accept pets, what will you do with this pet?*
What will you do with your pet when you travel?*
Where will the dog stay when you are home?*
Where will the dog stay when you are out of the house?*
Please describe your typical schedule with respect to when you are home vs away. How much time will the animal regularly spend alone?*
Are you prepared to allow the animal a minimum of two weeks to adjust to its new home?*

YesNo
If your pet becomes suddenly ill, are you willing and able to afford a bill of $100-$400+ for emergency veterinary care?*

YesNo
Are you willing to treat a lifelong medical condition if it developed?*

YesNo
Are you willing and able to dispense monthly preventative medications (i.e. heartworm)?*

YesNo
If the foster animal becomes suddenly ill or injured, are you able to manage veterinary visits and after-care? (not financial responsibility)*

YesNo
Are you willing to dispense scheduled medications, if necessary?*

YesNo
Do you agree to scheduled walks with the dog (separate from playtime and regardless of having a fenced yard)?*

YesNo
Do you have any known travel plans that would require East CAN to coordinate alternative care for the foster dog in your absence?*

YesNo
If travel plans exist, please indicate when and for how long.*
What would cause you to be unable to care for this dog any longer?*
Have you owned any pets in the last five years that you no longer own?*

YesNo
If yes, please elaborate on each, including species/breed, where the animal was housed and why you no longer own this animal.
If you currently have or have had a pet in the recent past, please provide your current and past veterinarians' contact information.
Current Vet Name

First NameLast Name
Phone Number

Area CodePhone Number
Past Vet Name

First NameLast Name
Phone Number

Area CodePhone Number
Other Information
How did you find out about East CAN?

www.eastcan.orgPetfinderAdopt-a-PetFacebookInstagramCommunity EventFamily/FriendOther
Is there anything else you want us to know, including information you did not have room for above?
References
Please provide a non-family reference who can speak about your capacity to love and care for an animal (i.e. vet, pastor, neighbor, friend).
Reference *

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Relationship to you
Agreement
Mark each box to indicate that you have read and accepted each statement.*
Signature*
Full Name*

First NameLast Name
Date*

MonthDayYear
Date
Should be Empty:

Application to Foster or Adopt

Contact Information

Environment

Pet Care

Other Information

References

Agreement