Birthdate: (Must be 18+ Years of age)*
Any violent criminal history for anyone living in the household? *
If Mobile Home/Trailer:
Is your mobile home within a community/park that you provide lot rent?
Does Not Apply
If Yes, please provide the Mobile Home Park's information in the rental 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?
Fully Fenced Yard
Partially Fenced Yard
Fence Type and Height: (if applicable)
If no fence, How will the animal be contained outdoors?
FULL Name, 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?*
List All Other Pets in the Home and Provide All Info Asked Below:
UTD on shots
Please provide a 5 year pet history. Including Name, type, age they left your home and why they left your home (death, rehome etc…)*
Current Vet Name:
Vet's Phone Number:
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?
What size of dog best suits your current/upcoming living arrangements, overall environment, and comfort levels?
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
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?