Foster Application Form

How did you hear about us?

Full Name*

First NameLast Name

Date of Birth?

E-mail*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number - Home*

Phone Number - Cellular*

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 an animal?*

YesNo

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

Do you have a preference in of Dog or Cat for foster?*

DogCatEither is Fine

Do you have a preference in sex of foster?*

MaleFemaleNo Preference

Are you willing to foster an animal of any age?*

YesNo

If not, what age would you consider?

If fostering a dog. What size dog are you willing to foster? (Check all that apply)*

SmallMediumLargeI am fostering cats only

Please describe the type of dog or cat 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 animal 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 preventatives?*

YesNo

We cannot guarantee an animal 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 animal?*

YesNo

If Yes please explain

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

YesNoI am fostering cats only

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.*

Vet Reference: Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Reference #1: Full Name*

First NameLast Name

Relation to applicant(s):*

E-mail*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Reference #2: Full Name*

First NameLast Name

Relation to applicant(s): *

E-mail*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Reference #3: Full Name*

First NameLast Name

Relation to applicant(s):*

E-mail*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

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 MILES TO FREEDOM 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 MILES TO FREEDOM 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 animals actions at all times, and release MILES TO FREEDOM from any liabilities or damages that may be incurred because of fostering such animals. I agree to have MILES TO FREEDOM 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 animals anymore that I will return said anmals to MILES TO FREEDOM and try to give MILES TO FREEDOM a 2 week period to try and find another suitable foster for the animals.

Date*

MonthDayYear

Your name*

E-mail*

example@example.com

References: