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 CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country 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 Circle option that describes your normal day* Home all day Out part-time Gone 7-10 hrs daily Indicate pets currently living with you* DOGS CATS BIRDS OTHER OTHER*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 IndoorsBasemenGarageClosed 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
