Foster Application

First name

Last name

Email

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Employer

General Home & Family Information

Are there children in the home?

Yes

No

If yes what are their ages?

Apart from the children listed above will the foster have exposure to other children under the age of 5?

Yes

No

If yes, please list age and relationship

Are there others living in the household?

Yes

No

If yes, please list age and relationship?

Does anyone in your household have asthma or allergies to animals?

Yes

No

If yes, please describe

Does anyone in your household smoke?

Yes

No

If yes please check all that apply

Smoke Inside

Smoke Outside

Both

What is your home level of activity? Please check all that apply

Busy

Calm

Quiet

Loud

Do you rent or own your home?

Rent

Own

If renting, please include landlords name and phone number

What type of dwelling do you live in?

Apartment no yard

Apartment with yard

House no yard

House with yard

Please describe yard

Animal History

Have you ever fostered for any other shelters or rescues in the past?

Yes

No

If yes, please describe

Have you ever personally given up an animal to a shelter or found a new home for an animal in your care?

Yes

No

If yes, please give details

Current Pets in Your Household

Do you currently have pets at this time?

Yes

No

If yes please fill out the following information on each pet you have in the home

Breed, Age, Sex, Vaccination Status, Heartworm Status, Spayed/Nuetered Status, Indoor or Outdoor pet?

Why do you want to foster for HEART?

Who will be the primary caregiver to your foster animal?

Have you considered the emotional impact of caring for this animal and then giving them up?

Would you consider fostering a 'special needs' animal?

Yes

No

Are you considering adopting at this time? If yes, please give details

Are you prepared to open your home to potential adopt for meet and greet appointments? If no, please describe

Do you have a vehicle to transport your foster animal to and from vet appointments if needed?

Yes

No

What type of animal activity level do you feel would best suit your home?

Couch Potato

Average Activity

High Activity

Other

Do you feel you can handle an animal who exhibits behavioral or adjustment issues (could include, but not limited to, dominance, food possession issues, object aggression, separation anxiety, fear issues)? Please share any concerns

Where will the animal stay when you are at home?

Where will the animal stay when you are away (i.e. at work)?

How many hours a day will the animal be at home alone?

How many hours a day will the animal spend outside?

Where will the animal sleep at night?

Would you be willing to use a crate?

Yes

No

What kind of solution would you be willing to try if housebreaking accidents occur?

Would you allow HEART to periodically drop in for a home visit?

Two Personal References. Please include the name and telephone number of each

Vet Reference. Please include name of clinic, address and telephone number

By signing below:

I certify that the information I have given is true and recognize that any misrepresentation of facts may result in the loss of foster privileges with HEART.
I understand that HEART has the right to deny my request to foster an animal.
I authorize investigation of all statements contained in this application.

Signature

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Date

Year

Month

Day

Foster Application

General Home & Family Information

Animal History

Current Pets in Your Household

Contact Details