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Chances Animal Rescue
Copyright © 2009 - 2013
All Rights Reserved
If you are interested in fostering our homeless companions, please complete this Foster Care Application.
Personal Information  
Name
  (First, Middle Initial, Last)
Date of Birth
Street Address
City, State, Zip
Home Phone
Cell Phone
Work Phone
Email Address
Employer
Occupation
What is the best way to reach you? Home Phone; Cell Phone; Work Phone;  Email
What is the best time to reach you?
Emergency Contact Name
 and Phone Number		 Name:
Phone Number:
Spouse/Roommate/Partner's name (if applicable)
Name and Ages of Children living or visiting with you (if applicable)
   
Property Information  
What type of home do you live in?
If other, please explain:
Do you Own or Rent?
If you rent, do you have permission from your Landlord to have pets?
If you rent, please provide your Landlord's Name and Phone Number Name:
Phone Number:
Do you have a fenced yard?
If yes, height of fence
   
Caretaker Information  
Who will be the primary caretaker for the foster animal(s)?
Where will the foster animal(s) be kept during the day?
Where will the foster animal(s) be kept during the night?
Hours caretaker will be home
Will there be another person available to help out?
If so, who?
How many pets are in your home at the present time?
Please give the names and information for the current animals in your household, and any you have had in the last five years
Type of Animal Breed Age Sex Spayed/Neutered
Are your pets current on vaccinations for:

(Please check all boxes that apply)

   Distemper

  Parvo

  Lepto

  Parainfluienza

  Rabies
Please list your current veterinarian and any veterinarians you have used in the past. Vet/Clinic Name:

Vet's Phone Number:

Vet's Email Address:

Name on your account:

Past Vet Info:
We will contact the vet to verify your current pets are up to date on shots.  This is a requirement for foster care homes.
   
Foster Interest  
What type of animals are you willing to foster?

(check all that apply)

   Dogs

  Puppies

  Cats

  Kittens

  Females

  Males

  Pregnant / Nursing Mothers

  Injured Animals

  Sick Animals

  Abused / Neglected Animals

  Animals with Behavior Issues

  Special Needs Animals

  Active (over active) Animals
Some of our foster animals are sick and need additional care.  Are you comfortable giving medications?
Check boxes if you are comfortable with any of the following

(check all that apply)

   Bathing

  Grooming

  Clipping Nails

  Caring for injuries

  Housetraining a dog

  Exercising a dog

  Socializing shy / scared pets

  Bottle feeding babies
How many pets are you willing to foster at one time?
How long are you willing to foster this animal(s)?
   
Additional Information  
Please provide two non-related references:  
Reference #1 Name
Reference #1 Phone
Reference #2 Name
Reference #2 Phone
   
Please provide any additional information that you feel we should know
   

By submitting this form, I/we acknowledge that the information on this form is true and correct. I/we agree to all provisions indicated on this form. I/we understand that any misrepresentation of fact may result in Chances Animal Rescue Inc. refusing adoption privileges to me/us. If my/our request for fostering is approved and later Chances Animal Rescue, Inc. discovers the above information is not true or correct, this application becomes null and void, and because of my breach of contract, Chances Animal Rescue, Inc. reserves the right to remove the foster pet from my home, and I will be held responsible for any associated legal costs incurred as part of said reclamation process. In order to ensure the best foster homes for our rescued pets, we reserve the right to deny any foster application.

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