Application to Foster or Adopt

Which role are you applying for?

I am looking to foster ...

Which pet are you specifically interested in?

If applicable

Please indicate the type(s) of foster you would like to be:

What qualities are you looking for in a dog? (Please check all that apply)

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)?

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

If yes, please describe and explain.

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?

Have all the adults in the household agreed to welcome this dog to your family?

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?

How long have you lived in this residence?

Do you Own or Rent?

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?

If restrictions apply, provide specifics (i.e. number of animals, weight limits)

Is anyone in the household allergic to pets or have asthma?

If known allergies or asthma exist, please elaborate.

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?

How much time will the dog spend outside unsupervised?

How will you keep the dog confined to your property?

If fenced, indicate the fence height and type. If other, please elaborate.

Do you plan to move in the near future?

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?

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

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

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

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

Are you willing to dispense scheduled medications, if necessary?

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

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

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?

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

How did you find out about East CAN?

Is there anything else you want us to know, including information you did not have room for above?

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

Mark each box to indicate that you have read and accepted each statement.

Signature

Full Name

First NameLast Name

Date

Application to Foster or Adopt

Contact Information

Environment

Pet Care

Other Information

References

Agreement