Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

What kinds of animals are you able to foster?

Dogs Cats Other

If other, please specify.

Please specify species/size/sex/age, etc.

Have you ever owned a pet?

Yes No

If yes, what kinds of animal(s)?

Which of these pets do you still own? (describe species, age, sex, etc.)

Are these animals spayed/neutered?

Yes No

Are they up to date on their shots?

Yes No

If you currently own pets, who is your veterinarian?

Which pets do you no longer own?

What happened to them?

Are there any children in the household?

Yes No

If yes, what are their ages?

Do you live in....

Own home
Rented home
Military housing

If renting, please give the name and phone number of the landlord/apartment complex.

Do you have a fenced in yard?

Yes No

If yes, what is the type and the height of the fence?

Where will the animal(s) be kept while in your care?

How many hours will the animal(s) be left unattended?

For how long would you be able to house an animal (e.g. two days, a week, a month, indefinitely, etc.)?

Are you willing to transport the animal to adoption days and/or the vet?

Additional information you may wish to give.