Your First and Last Name

Email Address

Your phone number

Name of animal you wish to adopt or foster?

Your street address

Street address line 2

City

State

Drives license: state and number

Who is your current employer?

How many adults live in the home besides you?

How many children live in the home?

Spouse or roommate name

Spouse or roommate phone number

Please list names of all adults living in your home if not already listed above.

What are the ages of the children?

Have all adults in the home agreed to adopt? Have all adults in the home agreed to adopt? Yes No Not Applicable

Anyone in the household allergic to animals? Anyone in the household allergic to animals? Yes No

Do you rent or own your own home? Do you rent or own your own home? Rent Own Other

Please list your landlord's name and phone number.

Please share your living circumstances.

Do you have yard space for your pet? Do you have yard space for your pet? Yes No Other

How many acres or lots is the yard available for your pet/s to roam?

Is your yard or acreage fenced? Is your yard or acreage fenced? Yes No Other

What type and size is your fencing?

Why did you select "other" for fencing? Please share details.

Please share why you chose "other" for yard space.

Do you currently have any other pets? Do you currently have any other pets? Yes No

How many pets do you own?

Please list pet type (dog, cat, bird), pet breed, pet name, age, and whether they are spayed/neutered and up to date on shots.

Please list your current veterinarian's name and phone number. (If no current vet, but have a history of pets list previous vet clinics. Enter none if you've never had a vet.)

Have you ever been charged with animal abuse or neglect related crime? Have you ever been charged with animal abuse or neglect related crime? Yes No

Have you ever given away or surrendered an animal for any reason? Have you ever given away or surrendered an animal for any reason? Yes No

Please describe circumstances for surrendering or giving away the animal/s.

Where will your new pet be kept during the day?

Where will your new pet be kept during the night?

How many hours are you typically gone from the house each day for either work, school, volunteering, or other? Please share details.

Do you currently foster for any rescue organizations or shelters? If so, share name of contact and phone number.

Have you read the Release of Liability terms and agreement, and do you understand and agree to those terms? Have you read the Release of Liability terms and agreement, and do you understand and agree to those terms? Yes, I have read and agree to the terms outlined in the Release of Liability Terms Agreement.

Anything else you wish to share?