First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone*

Alt Email*

Text/Pager Email*

What is the best time to reach you?*

What is your birth year? To be considered for adoption you must: • Be at least 23 years old. • Have knowledge and consent of all adults living in your household • Have a valid government-issued photo ID • Have landlords consent to bring an animal onto the property (if renting) • Understand that LMP reserves the right to refuse any adoption application for any reason • Be aware that all animals require a home visit before adoption *

Please list the names, ages, and relation of all adults in the household:*

Please list the names, ages and relation of all children in the household:

What type of housing do you live in? (Apt/condo, Townhouse, single family...)*

Do you own or rent? If you rent, please list the contact information for your landlord. *

How long have you resided at this address?*

Do you have a fenced in yard? If so, briefly describe it:

If not, how will you exercise your foster dog if applying for fostering a dog?

Have you ever owned a dog or a cat before? If so, what particular breeds?

What kind of experience have you had/have with dogs or cats? (training, vet tech, groomer, agility, happy pet owner, etc)

Have you ever fostered an animal before? If so, what was your experience? *

What pets do you current own? Is your pet(s) spayed or neutered and up to date on vaccines? How long have you owned them?

How many hours per day will the foster animal be left alone?*

Where will the foster animal stay during the day? During the night?*

Who will be the primary caretaker?*

Is anyone in the home allergic to dogs or cats? If yes, how do you plan on managing the issue?*

If there are no children living with you, are there children that visit, for example, grandchildren, children you babysit, etc?

How often do you travel? Are you planning a vacation in the near future?*

Have you ever crate trained a dog?*

Are you willing to have someone from LMP visit your home for a home visit?*

Are you able and willing to cover the costs of caring for a foster dog except for medical expenses? For example, food, flea prevention, etc.*

Have you ever surrendered an animal to a shelter or rescue? If yes, please detail the circumstances.*

Please supply names and telephone numbers for 2 personal references, including your veterinarian.*

By typing my name and today's date below, I acknowledge that I am signing electronically and agree that: ALL OF THE INFORMATION I HAVE PROVIDED ON THIS APPLICATION IS, TO THE BEST OF MY KNOWLEDGE, TRUE AND COMPLETE. I UNDERSTAND THAT FALSIFYING ANSWERS ON THE APPLICATION, OR AT ANY OTHER TIME DURING THE FOSTERING PROCESS, DISQUALIFIES ME FROM FOSTERING.*

I understand and agree to all information provided to me in my application process. If the animal I foster is on medication I will continue the medication as directed. I will not let the animal out loose by itself. If during the time I am fostering the animal it requires medical attention I will contact LMP first unless it is an emergency. I understand the foster animal is the property of LMP and will not sell, trade or dispose of the animal. I understand the importance of my own animals being up-to-date on all standard vaccinations and have provided LMP with a current shot record for each one.

I understand that anyone interested in adopting my foster dog, cat, puppies or kittens (including myself) must go through the standard adoption process, and approval of candidates and placement of animals is up to LMP. (Of course we welcome your referrals). Please type yes or not*

I understand that although LMP takes reasonable care to screen animals for foster care placement, it makes no guarantee relating to the animals’ health, behavior or actions. I understand that I receive foster care animals at my own risk. I indemnify and hold the LMP and all of its employees and board members free and harmless from all liability arising out of any and all claims, demands, losses, damages, action, judgment of every kind and description which may occur to or be suffered by me, members of my household, my own animals or any third parties by reason of activities arising out of this agreement. I release LMP from responsibility for any diseases that may be contracted by my resident animal(s) from the foster animal. Please type yes or no*

I understand that I am not to go on social media and discuss situations with Libby and Mace's Place Rescue without first discussing the issue or concern with any or all board members of Libby and Mace's Place Rescue. Please type yes or no. *