Part I: Personal Information

Name:                                                                 Date:

Address:

City:

State:

Zip:

Evening Phone:

Daytime Phone:

E-mail address:

Number of adults in the household:

Men                 Ages:

Women           Ages:

Number of children in the household:

Boys           Ages

Girls           Ages

Are you expecting a child or planning a family in the near future?

Type of Dwelling (circle one): House  Apartment  Trailer      Condo/Townhouse 

                                 Duplex/Triple              Other - explain:

Do you own or rent? (circle one):  own                  rent

What kind of animal(s) are you willing to foster? Be specific as to age, size, and any other requirements you feel are important.

   Dogs        Cats        Reptiles        Horse      Other (please elaborate)

do you have the landlord’s permission to keep a pet?  yes     no

Please provide Landlord/Apartment contact information for verification:

How many consecutive hours a day are you away from home for work, school etc.?

Would you be willing to allow us to visit your home? (circle one):   yes     no

Part II: Environmental Information

How large is your yard?

Is it securely fenced? (circle one):   yes     no                     If yes, what type fence & how tall?

 Do you have a pool? (circle one):   yes     no

If yes, is it securely fenced? (circle one):  yes     no

Part III: Pet History

Please List All Pets Currently Owned

Type/Breed

Age

Spayed or Neutered?

Stay Indoors or Outdoors

When nobody is home, where does your pet stay? (circle one):

  In the yard     In a crate     In the garage     In the house confined to an area

 In the house not confined to an area     In the house with a doggie door                      In an outdoor dog run/pen

 Where would your foster pet sleep? (Be specific)

Do you consider your current pet(s) aggressive or submissive to other people? Animals?

How do you discipline your pet(s)?

Part IV: References

Please list three references that can attest to your suitability as a pet fosterer.  If you have owned any pets in the last five years, you MUST include your veterinarian as a reference.

Name Address City, State, Zip Phone

Reference #1 (current vet, if applicable)

Name Address City, State, Zip Phone

Reference #2

I, the undersigned, attest that, to the best of my knowledge, the above information is accurate and complete at the time of signing. I understand that falsely provided information can mean that my application will be terminated

 I also understand that the pets fostered in this program may have come from puppymills, or homes where domestic violence is present. Some have been dumped, chained or starved, and have possibly been abused. I understand these pets may exhibit stress/fear-related anxieties. I am willing and able to offer patience, kindness and compassion to these foster animals at all times.

I agree to uphold the standard of IL-MO Rescue at all times, and to always bear in mind that the animals' welfare and best interests are paramount. (please sign and date).

Signature                                                                                                              Date