Name
Address
City

State

Zip

Phone (home)		Phone (work)
FAX
Email
Name of Pet You Are Interested in Fostering.

Please indicate any restrictions on fostering
(i.e., weight limits, gender, types of dogs/cats)?
 

 

Are you interested in fostering a: Dog Cat Either

Who will be the primary caretaker of this pet?
 

 

Can you provide the pet(s) adequate shelter during the foster period?
  yes no

 

Do you live in a: House Apartment Condominium Mobile Home     Do You: Own Rent  

 

Landlord's Name and Phone Number: 

Do you have permission to have a dog/cat? Yes No

          

Do you have a fenced yard? Yes No   
Type and height of fence:

          Size of yard:  

          Where will the animal be kept during the day? 
           
          Where will the animal be kept during the night?
         

          Will this be your first pet? Yes No  

          Can you provide the pet(s) regular meals and nourishment? Yes No  

List any other pets you now have and if they are spayed/neutered and on heartworm prevention:
 

          Do your pets get along with other animals? Yes No  

          If you have had pets in the past 5 years, what became of them?
           

          Are your pets up to date on vaccinations? Yes No  

May we contact your Veterinarian? Yes No  

          Please provide name address and phone of most recent veterinarian:
         

Can you provide transportation to a veterinarian named by CARE for treatment approved by CARE? Yes No  

Do you understand that a pet placed with you for fostering will be owned by CARE and that any medical treatment or other veterinary services must be authorized by CARE? Yes No  

Do you agree that only CARE can transfer or permanently place any pets you may foster? Yes No  

          Number of adults in home:     Number of children in home:        
          Children's ages: 
         

Do all members of the household want to foster this pet? Yes No

          How long have you lived on your present location? 
        

          Do you anticipate moving in the near future? Yes No

          Are You Willing To Make A Commitment To This Pet? Yes No

 

Comments, questions, or additional information:

 

Have you read and do you agree to the terms of the Foster Family Agreement? Yes No