Foster Care Application "*" indicates required fields Step 1 of 2 50% Name*Date* MM slash DD slash YYYY Are you over 18 years old?* Yes No Address* Street Address City State / Province / Region ZIP / Postal Code Home Phone*Cell Phone*E-Mail* DL#*Do you own or rent the place where you live?*If you rent, are animals allowed?*If there are restrictions on animals, explain*If you rent or reside in another person's home, provide their name and telephone number:*NameTelephoneNumber of children in your household*Their ages*Do you have a yard?* Yes No Is the yard completely fenced?* Yes No Select option that describes your normal day* Home all day Out part-time Gone 7-10 hrs daily Indicate pets currently living with you*Name of your veterinarian:*Are your pets* Indoor only Outdoor only Both Are your pets current on their vaccinations?*Are all your pets spayed/neutered?* Yes No If no, please explain* What type of animal(s) would you like to foster? Young unweaned kittens without a mom* Yes No Young unweaned kittens with mom* Yes No Weaned kittens* Yes No Adult cats* Yes No Young unweaned puppies without a mom* Yes No Young unweaned puppies with mom* Yes No Weaned puppies* Yes No Adult dogs* Yes No Rabbits* Yes No Pocket pets [ferret, hamster, gerbil, etc.]* Yes No Sick or injured pets* Yes No Other* Yes No Specify*How long are you willing to foster at any one time*Are you willing to foster more than one animal at a time?* Yes No Any foster pet you take needs to get along with* DOGS CATS KIDS Where will the foster pet be kept? [indicate "day" with "D" and "night" with "N"]*Loose IndoorsBasementGarageClosed in a roomFenced yardPenLoose outdoorsTied outsideCrate or CarrierOtherHave you cared for young, unweaned puppies or kittens before?* Yes No If yes, explain*Have you ever given medication to sick animals before?* Yes No If yes, explain*IF NEEDED, are you willing to provide food and litter at your own cost for foster pets?* Yes No Have you fostered an animal before?* Yes No If yes, what organization did you foster for?*Agreement* I make the above statements and voluntarily enter into the agreement to provide a temporary home as a foster caregiver to any animals RBHAC may temporarily place in my care.*Applicant Signature*Date* MM slash DD slash YYYY CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. Δ
