Foster Home Information Packet

FOSTER HOME APPLICATION
Today's Date:	* required
Applicant information:
First name:	* required
Last name:	* required
Date of Birth:	* required
Must be 21 years of age or older to adopt
Driver's License No.:	* required
State:	* required
Occupation :	* required
Email address:	* required
Street Address:	* required
City, State, Zip:	* required
Home Phone:	* required
Cell Phone:
Alternate Phone:
Preferred way to contact you:	Email Home Cell Phone Cell Text
Co-Applicant or Spouse information:
First name:	* required
Last name:	* required
Relationship to applicant:	* required
Date of Birth:	* required
Must be 21 years of age or older to adopt
Driver's License No.:	* required
State:	* required
Email address:	* required
Street address:	* required
City, State, Zip:	* required
Home Phone:
Cell Phone:
Alternate Phone:
Preferred way to contact you:	email Home Cell Phone Cell text
About Your Home:
What type of home do you live in?	Single Family Apartment Condo Mobile Home Farm
Do you have a fenced in yard?	* required
Height of fence?	* required
Type of fence:	Wooden Chain Link Electric Split Rail Concrete Wrought Iron Other None
Do you Own, Rent, Other?	* required
If you rent, please answer the following 4 questions.
Does your rental agreement allow for pets?	* required
Is there a weight limit?	* required
How much is your pet deposit?	* required
Landlord Name:	* required
Landlord Phone Number:	* required
What is the traffic like around your home?	Country road Residential - busy Resident - quet Busy
About your family:
How many adults live in your home?	* required
Do all adult members of your household want to foster?	Yes No
Do you have any children living in your home?	* required
If yes, how many and what are their ages?
Is anyone living in the home allergic to animals?	* required
How would you describe your household activity?	Grand Central Station Couch Potato In between
About your current pets:
Please list all pets you currently own or reside in your home.
1.) Please include name, type and age:	* required
2) Please include name, type and age:
3) Please include name, type and age:
4) Please include name, type and age:
5) Please include name, type and age:
Please provide any additional information on your current pets you feel we should know:
About your past pets:
Please list pets you have owned in the past 5 years.
1) Please include name, type, age and how long owned:
2) Please include name, type, age and how long owned:
Please provide any additional information on your past pets you feel we should know:
What happend to the pets you no longer own?
Your Veterinarian:
Please provide information of the veterinary clinics who have provided medical care for your pets past and present.  Out of State veterinarians are ok.
Name of Veterinarian or Clinic:	* required
Veterinarian phone number:	* required
Some Veterinarians require that the owner calls to release information.
Will you call to give permission to release information about your pets?	* required
What owner name are the pets listed under?	* required
Foster Preferences and Care:
Why do you want to Foster ?	* required
Where will the foster pet stay when you are away from the house?	* required
How long will the foster pet  be without human companionship each day	* required
Where will the foster pet sleep?	* required
Are you willing to crate train your foster pup?	* required
Are you willing to potty/litterbox train your foster?	* required
Are you willing to leash train your foster pup.	* required
What pet(s) are you interested in fostering?	* required
Check all that apply	Puppy under 6 months Kitten under 6 months Puppy 6months - 1 year Kitten 6months - 1 year Adult dog over 1 year Adult cat over 1 year Momma dog with newborn puppies Momma cat with newborn kittens Bottle babies (puppies) Bottle babies (kittens) Select all that apply (Ctrl to select multiple)
Are you willing to transport your foster pet.	* required
Check all that apply:	To all adoption events and drop off To all adoption events and stay and help To all veterinarian appointments (Concord) To meet with potential adopter Select all that apply (Ctrl to select multiple)
Are there any breeds, behaviors or conditions you are NOT willing to foster?
Is there any additional information you would like to provide?
Personal References:
Reference #1 Name:	* required
Phone Number:	* required
E-Mail:
Relationship to applicant:
Reference #2 (not a family member) Name:	* required
Phone Number:	* required
E-Mail:
Relationship to applicant:
	Before you click on the submit button, please review your application and be sure that you answered all questions especially the questions with *required next to them.  If any of those fields are not filled in, your application will not be submitted.  You will know that your application has been submitted successfully when you are directed to our page that tells you your application has been submitted.