First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Cell Phone

Birthdate: (Must be 18+ Years of age)*

Any violent criminal history for ANYONE living in the household? *
Choose one: Yes No

Housing*
Choose one: Own Rent

Housing Type
Choose one: Apartment Condo Duplex Farm House Mobile Home Town Home Other

If Mobile Home/Trailer: Is your mobile home within a community/park that you provide lot rent?
Choose one: Yes No Does Not Apply

If Yes, please provide the Mobile Home Park's information in the landlord section of this form.

RENT: Landlord's name and phone number. NA if not applicable.

Landlord's Email Address:

Do You Have a Fenced Yard?
Choose one: Fully Fenced Yard Partially Fenced Yard No Fence

Fence Type and Height: (if applicable)

If no fence, How will the animal be contained outdoors?

FULL Name, include maiden name, or other names used, Birthdate and Occupation of All Adult Members Living in the Residence*

How many children living in the residence? *

Ages of Children in Residence (Check All That Apply):

Do you currently have pets?*
Choose one: Yes No

List ALL Pets in the Home & Provide All Info Asked Below: *Incomplete applications will be rejected* Pets Name: Type: Age: Spayed/Neutered: Most recent Rabies Vaccine: Most recent Distemper Vaccine:

Please provide your 5 year pet history include: Name, type, age, they left your home and why they left your home (death, rehome etc…) IMPORTANT: If your resident pet is not utd or altered we cannot process your application without a vet verified medical reason. We will call to verify, please give your vet clinic permission to speak with MSAR or we cannot process your application. *

Current Vet Name: *

Vet's Phone Number: (Required field: If no vet, please enter NA)*

Vet's Address:

What type of animals would you like to foster?

How many animals would you like to foster? *

What age of pet best suits your and your family's energy level, hobbies and lifestyle? (Check All That Apply)

Where will the animal be while you're home?*

Where will the animal be while you're sleeping?

Where will the animal be while you're not home?*

On average, how many hours will the animal be left alone per week?

Preference to Male vs. Female?
Choose one: Male Female Doesn't Matter

What size of dog best suits your current/upcoming living arrangements, overall environment, and comfort levels? *
Choose one: Small Medium Large Extra Large Doesn't Matter Not applicable

What Behaviors and other situations are you able to accommodate and work through with staff support?

Please detail what experience you have in regards to animals along with the type of animal?*

Reference #1: Full Name (References can NOT be family members or related)

Reference #1: Phone Number

Reference #1: Email

Reference #2: Full Name (References can NOT be family members or related)

Reference #2: Phone Number*

Reference #2: Email

Comments:

I Certify That the Above Information is True and Accurate and I Have Read the Disclosure Above: (enter name for signature)*

How did you hear about us?