FOSTER APPLICATION

Application Type
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I AM INTERESTED IN FOSTERING:







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Sex preference


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Size preference



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Breed specific
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How long can you foster?
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PERSONAL DATA

First Name:
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Last Name
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Street Address
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City
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County
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State
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Zip:
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Home Phone:
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Work Phone
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Mobile Phone
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Email Address:
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Are you 18 years of age or older?

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Work hours
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Number of persons in household:
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Ages of Children
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Is there a fenced area in your home? If so, what type of fence and area?
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PET HISTORY


Please list all pets for which you, as an adult, have or have had responsibility within the last 10 years:


******* PET 1 *******

Pet 1 Type/Breed:
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Pet 1 Name
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Pet 1 Sex
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Pet 1 Age
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Pet 1 - Spayed/Neutered
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Pet 1 - Vaccinations (Rabies & HW preventatives)
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Pet 1 - How Long in your Care?
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Pet 1 - Where was this pet kept?
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Pet 1 - Where is the pet now?
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***** PET 2 *****

Pet 2 Type/Breed
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Pet 2 Name
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Pet 2 Sex
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Pet 2 Age
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Pet 2 Fixed?
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Pet 2 - Vaccinations (Rabies & HW preventatives)
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Pet 2 How Long in your care?
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Pet 2 - Where was this pet kept?
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Pet 2 - Where is the pet now?
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***** PET 3 ******

Pet 3 Type/Breed
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Pet 3 Name
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Pet 3 Sex
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Pet 3 Age
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Pet 3 Spayed/Neutered
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Pet 3 Vaccinations (Rabies & HW preventatives)
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Pet 3 How long in your care?
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Pet 3 Where was this pet kept?
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Pet 3 - Where is the pet now?
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***** PET 4 *****

Pet 4 Type/Breed
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Pet 4 Name
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Pet 4 Sex
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Pet 4 Age
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Pet 4 - Spayed/Neutered
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Pet 4 - Vaccinations (Rabies & HW preventatives
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Pet 4 - How long in your care?
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Pet 4 - Where was this pet kept?
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Pet 4 - Where is the pet now?
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Were any of your animals:





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If Yes, please explain:
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Who is your Current veterinarian (if you currently have pets):
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Veterinarian Phone
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Do we have your permission to contact your veterinarian for a reference?

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To the best of your knowledge, has any member of your household ever been convicted of an animal welfare law violation such as neglect, cruelty, abandonment, etc.?

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Any other information you feel we should know in considering your application:
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Digital Signature (type full name)
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Signature Date:

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