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Today's date:
First name: Last name: Current Street Address: City: State: Zip Code: Home phone number: Work Phone number: E-Mail: Occupation:
Why do you want to foster a pet?
What type of animal are you interested in fostering?(Please check all that apply) Cat Dog 1. Age: (3-6 Mos.) (6 Mo-1 Yr) (1 Yr +) Special Needs 2. Sex: Female Male 3. Hair: Short Medium Long
When home alone, where will the animal stay? Basement Garage One Room in the House Run of the House Outdoors Other
Where will the animal sleep at night?
When will the animal be allowed outside? When I am home On a leash On deck or patio On screened patio Out during the day; in at night Never When the cat wants Other
Have you ever owned a pet before? YesNo If yes, please provide a history of your pets past and present: Do you currently have pets?YesNo Who is your veterinarian? Veterinarian phone:
Please list family members (including yourself) who will have contact with this animal:
Do you live in: Apartment Condominium Mobile Home Single Family Home Townhouse Do you rent your housing?YesNo
You will be contacted as soon as your application is processed. Please expect to be contacted within 72 hours.