C.A.R.E. Foster Home Application

PERSONAL INFORMATION    Date of application___________________

Name_______________________________________________________________________

Address_____________________________________________________________________

City, State, Zip_______________________________________________________________

Phone_____________________________ e-mail____________________________________

Employer______________________________________ City__________________________

Occupation_____________________________ Typical # hours worked daily _____________

Name of Co-Applicant (Adults over 18 yrs old) _____________________________________

Relationship to Applicant: Spouse____ Significant_____Roommate_____Other________

Employer:_____________________________________ City__________________________

Occupation:____________________________ Typical # hours worked daily _____________

BACKGROUND INFORMATION

1.Humans in the household? Adult______________ Ages______________________________

                                                                        Children________________________________

                                                                        Ages___________________________________

2.If there are children in the household (including visiting grandchildren), are

they experienced with dogs/cats? ____________Yes _____________No

3.Who would have primary responsibility for caring for a foster dog/cat? ____________________

4.Do you have any health problems, which might affect your fostering? ____________________

5.Are you willing/able to adjust your schedule (if needed) while a foster dog/cat becomes

acclimated to your home? ___________How?_______________________________________

6.Is there anyone home during the day?_____________

Who?_____________________________

7.If not, how long will the foster dog/cat be left alone?_________________Where will he or she

be kept while alone?_______________________________________________________

8.Are you comfortable with _______________housetraining _____________________shy dog/cat

_____________________active dog/cat

9.Are there restrictions on how long you can foster a dog/cat?______________________________

10.Are you prepared to commit to fostering, knowing that a foster could possibly stay in your

home for several weeks or months?____________________________________

11.When would you be able to start fostering? ___________________________________________

ENVIROMENT

12.Do you live in a ____house _____townhouse______apartment_______mobile home

____________other

13.Do you _________________own ________________rent

14.If you rent, what is the landlord’s policy on pets? _______________________________

15.Do you have a fenced area for exercise?________________________________________

16.If you do not have a fenced area how will you provide exercise? ____________________

17.How will the dog potty? ______________________________________________________

18.Who will be the primary person responsible for exercising the foster dog?

19.Where will the foster dog/cat spend its daytime?___________________________________

20.Where will the foster dog/cat sleep at night? ______________________________________

21.Do you have pets in your home now? ________________Yes _________________No

22.If yes, please list all pets, Sex, breed, ages, spayed/neutered.

Dogs_______________________________________________________________________

Cat’s ________________________________________________________________________

Other_______________________________________________________________________

23.Do your pets live ____inside _______mostly inside ________mostly outside______outside

24.Are your dogs trained?_______________Yes _____________No

25.What types of dogs/cats are you willing to foster? __________Males ____________Females

_______Adults _______Puppies ___________Dogs taken from private owners

______Dogs/Cat taken in from shelters ______Abused/Neglected dogs/cats

____________Injured/sick dogs/cats _____________Kittens

26.Do you have a veterinarian?___________________________________________________

References:

Please list 2 references and telephone numbers:

I acknowledge that the information contained in this form is true and correct to the best of my knowledge. I also understand that C.A.R.E. will not be responsible for any damage by the fostered animal.

Signature of Applicant__________________________________Date_________________

Signature of Co-Applicant_______________________________ Date_________________