First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

Text/Pager Email

Have you ever been convicted of animal cruelty, neglect, or abandonment?*
Choose one: Yes No

Type of animal you are willing to foster: (Please include species, breed, age, sex, coat length, personality traits, etc) *

Why do you want to foster an animal?*

Will you be able to take the animal to vet appointments and allow potential adopters to visit the animal?*
Choose one: Yes No

Are you willing and able to medicate an animal if necessary, even if it is only monthly heartworm pills?*
Choose one: Yes No

Do you have the consent of all individuals in your household to foster an animal?*
Choose one: Yes No

Are you willing to housetrain a dog or litter box train a cat?*
Choose one: Yes No

Are you willing to use a crate for a dog if recommended? *
Choose one: Yes No

What will you do if the animal soils the floor or chews/claws the furniture?*

Describe your home’s activity level: Busy/noisy, moderate comings/goings, or quiet/occasional guests.*

Please list the ages of all children residing in your household*

Is anyone in the house allergic to dogs or cats?

Does anyone in your household have a fear of dogs or cats?*
Choose one: Yes No

PETS CURRENTLY OWNED (name, dog/cat, breed, age, sex of each, Spayed/Neutered, Vaccines Y/N, Length of ownership, indoor/outdoor) Example: Buster, Dog, Lab Mix, 8 years, Female, Spayed, Yes, 5 years, both.*

List previously owned pets, dates owned, and what happened to that pet:*

Have your current pets been exposed to and are tolerable of other pets?

Under what circumstances would you consider giving up your foster pet?
Choose all that apply: Barking Housebreaking Chewing Jumping up Shyness/other fears Shedding Digging Scratching or climbing on furniture none: I am committed to working with the animal Other, Please specify in the space below

Other:

Animal experience, activities, or any other information you think it would be helpful for us to know about:*

Where will the animal be kept when you are home?*

Will the animal be kept inside or outside*
Choose one: Inside Only Outside Only Inside and Outside

How much time will the animal spend alone during the day?*

Where will the animal be kept when you are not at home?*

Where will the animal sleep?*

List at least one reference (who is not a family member) including first/last name and a phone number.*

Veterinarian's Name and Phone Number*

Do you have a fenced yard?

What is the height of the fence?*

What type of fence?

In what type of home do you live?

Do you own or rent your home?

Who in the household will care for the pet?*

How many total people reside in your household (including children listed above)? *

RENTERS ONLY: Have you received the approval of your landlord to have an animal?

RENTERS ONLY: Please enter your landlord's name and phone number

By submitting this form to Surry Animal Rescue, I attest that the information entered above is true and accurate. Please enter your name and date:*