Pawsitive for Heroes Foster Application

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Cell Phone

Email*

How did you hear about us?*

Do you currently*

Rent
Own
Live with others
Other

If renting is landlord aware of your considering to foster*

yes
no

Do you currently drive?

yes
no

If yes, please provide license #*

Do you have reliable transportation?*

Yes
No

How would you provide medical emergency attention if needed?*

Have you ever been arrested or charged with the following?*

DWI
DUI
Domestic Violence
Child Abuse
Animal Abuse
None of the above

City/town village charged in:*

Landlord Information

Landlords Name*

First Last

Phone*

Address*

City State / Province / Region ZIP / Postal Code

Do you currently have other animals?*

yes
no

If yes how many?*

What type/kind?*

Are your current pets spayed/neutered?*

yes
no

Are current animals up to date on all shots?*

yes
no

Do you currently have a fenced in yard?*

yes
no

Do you plan on giving the dog free roaming of your home?*

yes
no

Where do you plan on placing the dog during the evening hours or while you are away from home?*

Veterinarian Information

Do you currently have a veterinarian you are using?*

yes
no

Name of Clinic:*

Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone:*

Fax:*

Do you have children residing with you?*

Yes
No

If so, how many?*

Please enter a number less than or equal to 30.

Ages*

Are you currently employed?*

Yes
No

If so, how many hours a week?*

Please enter a number less than or equal to 200.

How often will dog be alone?*

Have you ever fostered an animal before?*

Yes
No

Are you willing to provide food and other needs to the dog at your own expense?*

Yes
No

Would you be willing to give us feedback on your experience?*

Yes
No

Signature

Date