First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone

Work Phone
x

Cell Phone*

Year of Birth. *

If you are fostering a pet with a spouse or partner, please list his/her name Please note that because we consider fostering to be a family decision, spouses/partners will be asked to sign or give verbal agreement. Enter "N/A" if you are the only adult in the home.*

Emergency Contact Name and Phone Number (include relationship)*

Tell us a little bit about yourself and why you are interested in fostering at this time*

What type of animal are you interested in fostering? (Please check all that apply)

If you are interested in fostering a dog, what is the maximum weight that you are willing to foster?*

Is there a breed that you have specific experience with? Is there any breed that you will NOT foster?*

Are you willing to foster a dog going through heartworm treatment? *Note this is NOT required to be a foster parent.*

How much time will your foster animal spend without human companionship each day? *

If you work outside of the home for more than 6 consecutive hours, what plans do you have for a foster dog to relieve him/herself mid way through the work day?

Are you willing to use a crate to keep a foster dog confined when you are not home (and perhaps more often if the adoption coordinator or other board member deems it necessary for the dog's safety and/or proper rehabilitation)?*

Please explain the daily pet routine that you currently have or plan to have.*

Do you have evacuation plans that include your foster in the event of a hurricane or other event that requires evacuation? Please explain.*

If you have previously owned a pet as an adult, please tell us the breed of dog and what happened to him/her. Were your previous pets spayed or neutered?. If not, please explain.*

Please tell us about your current pet(s). Include name, breed, and age. What is the activity level of your current pet? If no current pets, enter "No current pets." *

Do your current pets stay outside or inside?*
Choose one: inside outside (more than 4 hours a day) doggy door N/A ( no current pets)

Where do your current pet(s) stay when you are not home? Enter "N/A" if no pets.*

What type of heartworm preventative do you/have you used? N/A if NEVER owned a pet.*

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Please list your Veterinarian's Name and Phone Number. If your pet(s) is listed under someone's name other than yours, please note. If you have NEVER owned a pet, please list the name and phone number of the vet you plan to use.*

Do you own or rent your home*
Choose one: Rent Own

If you rent, have you received the approval of your landlord to have an animal*
Choose one: Yes No I own my home

Please provide Name and Number of Landlord. Yes, we do verify that rental is pet-friendly! Enter "N/A" if you own your home.*

Do you have a fenced yard? Select all that apply.

What is the height of the fence? If unfenced how will you exercise and address potty issues?*

Is there a pool on your owned/rented property? *

Are all of the members of your household agreeable to fostering a pet?*

What are the ages of the children or grandchildren that will be exposed to your pet*

Do you or anyone in your family have known allergies to dogs or cats? *

As a foster parent, I agree to properly feed, house and tend to approved medical care for the foster animal. (please initial)*

As a foster parent, I agree to notify the Adoption Coordinator or a Board Member immediately should the foster animal require medical attention. (please initial)*

I agree to IMMEDIATELY notify the PAS director and apppointed board members at the emergency numbers provided to me if my foster pet should become lost. (please initial) *

As a foster parent, I understand that I will be responsible for any veterinary care costs, in whole or part, incurred by me without the prior approval of the Adoption Coordinator or Board Member. (please initial)*

As a fosterparent, I agree to keep an ID tag on any PAS foster pets in my possesion when in situations at risk for escape, such as walks, traveling/transport, or other outdoor events, or if otherwise instructed by a PAS Board Member or Coordinator.(please initial)*

As a foster parent, I agree to maintain open communication with the Adoption Coordinator or appointed Board Member(s) regarding, but not limited to weekly updates & medical emergencies (even if paid for in whole by me) (please initial)*

As a foster parent, I agree to return to the Adoption Coordinator or Board Member, the foster animal and any PAS property in the event that I am no longer able to foster. (please initial)*

If provided to me, I agree to keep any login information or access to any PAS databases/websites private, and to never share my login information or allow database/website access to anyone outside of PAS-approved membership, including family or friends. All information accessed is confidential, and I agree to not reveal or disclose any information for any purpose to any other person or other entity.(please initial)*

Waivers and Release of Liability: I understand that the behavior of domestic animals is sometimes unpredictable and that some domestic animals are capable of inflicting serious personal injury. I understand that working with animals may involve handling fecal materials. Knowing the risks of working with domestic animals, I agree to assume those risks and to release, indemnify and hold harmless Pet Adoption Services, Inc. and their agents, any venue, company, and/or property owner on which PAS-related events are held and their agents, forever from liability for any injuries or damages to any person, property, or otherwise, caused by my participation in said events and/or by any PAS foster animals, and from any causes of action, claims, suits, or demands whatsoever that may arise as a result of such injury or damages. (please initial)*

I certify that the information entered on this application is true. I agree that entering my name and date will serve as my signature. I further agree that if this application is approved, it will serve as my agreement to follow the rules set forth within it for fostering an animal with PAS. Upon approval of my application, PAS will give me a printed version of this application/agreement for my records.*

Please let help us to serve our rescued pets better by letting us know how you heard about us. If found us through the internet, please let us know through which website you were linked to us (Petfinder, Pets911, Adopt-A-Dog, etc.)

**For Office Use Only