First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
County*
Email*
Home Phone*
Work Phone x
Cell Phone
Alt Email
Please answer the following questions to help us understand your background as well as the type of foster home you can provide our animals.
Date of Birth*
If employed please list employer, position and number of years with the company.*
Please list the name, birthdate, and employer of each adult in the home*
Are you able to transport the animal(s) if needed for adoption hours, medical care, training, etc.?
Type of housing (house, apartment/condo, townhouse, other):*
How long have you lived at this address?*
Do you own your home?
Please list your landlord, home owners association contact, or property manager. Include name and phone number.*
Is your yard fenced
What is the height of the fence
What type of fence* Choose one: No Fence Partial Fence Chain Link Privacy Underground/Electric Wooden/Split-Rail Temporary Fencing Other
If rental or condominium, have you approved your foster status with the landlord or condo association?*
Please provide contact information for landlord or association:
Please list all other individuals living in your home: Name / Age / Relationship / Health concerns (allergies, mobility, etc.) *
Are all household members in agreement with bringing a foster animal into the home?
Which member of the household will be the primary caretaker of the foster animal(s)?*
What kind of animals are you available to foster? Please check all that apply.
Are you willing to foster animals with special needs? (check all that apply)
For what length of time can you foster an animal(s)?*
If you can foster a litter of puppies or kittens, how many are you able to foster? (Please keep in mind very young orphaned puppies/kittens may require feeding every few hours)*
Kittens and puppies sometimes come in with fleas, ear mites, ringworm, diarrhea, etc. Are you able to dispense oral and/or topical medication and provide basic medical treatment?
If necessary for the care of the foster animal or safety of your own pets, would you be able to provide complete separation of CARE foster animals from your own? (There are times when foster animals should be isolated from your own companion animals. A separate room or enclosed area with NO carpet will work best.)
Are you able to work with harsh cleaning chemicals such as bleach? (Between sets of foster animals you should thoroughly clean the foster area with a disinfecting chemical)
Are you prepared to deal with clean up and/or potential damage caused by a foster animal?
Are you able to monitor the health of the foster animals? (You will need to pay attention to signs of illness or worsening of symptoms and call LHAR if you are concerned)
Can you get to our vet quickly in case of an emergency?
What behavior problem(s) are you not willing to handle? (Please keep in mind that we can never be certain what type of behavior problems may exist until animals are placed in a home.)*
How many hours will the foster animal(s) be home alone during a typical day?*
Where will your foster animal(s) be kept during the day?*
What experiences, if any, have you had with animals?*
Why would you like to become a foster care provider?*
Have you fostered animals for other organization(s)?
If yes please explain.
Do you agree to never give a foster animal any medication - prescriptive or herbal - without consulting with a LHAR veterinarian or authorized LHAR personnel?
Do you understand that all animals are placed in your home on a temporary basis and when the foster requirements have been met (i.e., the animal is healthy or the goal age/weight has been achieved), and the animal will be available for adoption?
Do you understand that all animals placed into foster homes belong to LHAR and must be returned immediately upon request?
Do you agree to keep all foster cats inside your home and all foster dogs on a leash at all times when outside of the home?
Do you agree to notify LHAR if your foster animal exhibits any signs of aggression, health problems, or escapes from your home?
Do you agree to inform the foster lead of any changes in your address, phone, or foster status?
Please list the NAME and PHONE NUMBER of your current veterinarian. For animals that have passed away, please list the veterinarian they were seen by. We will confirm all your pets vaccinations with your vet. If you use multiple veterinarians please list them all. *
Please provide information regarding your pet(s) past and present. Name / Species / Breed / Age / Sex / Altered *
Are your current pets up to date on vaccinations?
If you have cat(s) were they tested for feline leukemia (FeLV) and feline aids (FIV)?
What were the test results of: FeLV
What were the test results of: FIV
Please indicate the last vaccination dates for your cat(s): (Distemper & Rabies)
If you have dog(s), please indicate the last vaccination date for: (Rabies / DHLPP / Bordetella)
Date of last heartworm test
Please note any additional information we should know about your resident pets:
Please feel free to ask questions about the program, or list any comments you would like to discuss with the foster coordinator:
Please list two references
#1 References Name*
#1 References Phone Number*
#1 References Address*
#2 Reference Name*
#2 References Phone *
#2 References Address*
As foster provider, please indicate your response to the following:
I will not use metal choke collars, prong collars on the dogs or employ harsh training.
I will not strike or choke the animal in an attempt to discipline.
I will not leave the dog outside in a yard or elsewhere without adequate adult supervision. I understand that foster animals are inside animals only.
I will not tie or chain a dog in the yard for long periods of time.
I will not allow unknown people or animals to approach the dog without being in full control of the dog and the situation.
I hereby acknowledge that all the information provided above is correct to the best of my knowledge. I also understand and accept full responsibility for the health risks to my own animals and all who reside in my home.
My signature indicates that I have read, understand and agree to abide by these terms.
Date:*
Signature*