Foster Application Form Foster Application Name * Name First First Last Last Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Phone Email Employer Occupation Which of the following pets would you be interested in fostering? Adult Cat Adult Dog Kitten Puppy Preferred gender of the pet Male Female No Preference Have you ever fostered an animal from a rescue/animal control agency? Yes No Have you ever had an application rejected for fostering an animal from a rescue/animal control facility? Yes No If yes, explain How many people currently reside in your household? Are there any children in the household? Yes No List ages Do you have any pet’s currently living in your home? Yes No If yes, list name, age, neutered/spayed status, breed, and time in your care for each Who is your current veterinarian? Please provide telephone number of this veterinarian Do you have a separate room or area in your home for your foster pet to stay? Yes No If you are interested in fostering a dog or puppies, do you have a backyard? Yes No If you answered yes to the above question, tell us about your yard- check all that apply Backyard with no fence Backyard with a fence Doggie Door How would you describe the activity level in your household? How long are you able to host a foster pet? 1-2 weeks 2-4 weeks 1 month /+ Are you comfortable medicating your foster pet if necessary? Yes No Approximately, how many hours a day will this pet be left unattended? Is there any other questions or information you’d like us to know to match you to a foster pet? By signing this form, I/we acknowledge that all information on this form is true and correct. I/we understand that any misrepresentation of fact may result in Cheyla’s Rescue Foundation refusing foster privileges to me/us. If my/our request for fostering is approved and later Cheyla’s Rescue Foundation discovers the above information is not true or correct, Cheyla’s Rescue Foundation reserves the right to remove the fostered cat/dog from my residence and assume ownership of the pet. Signature * signature keyboard Clear Date * Captcha Submit If you are human, leave this field blank.
