Foster Application - Mikaela's Mutt Motel

First Name *

Last Name *

Phone *

Email Address *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Date of Birth *

Over 21? *YesNo

Are any household members under 18 years of age? *YesNo

Please list ages of all household members younger than 18 years old: *

How soon do you want to foster? *

Do you own or rent your home? *OwnRent

Landlord/Management Company Name *

Landlord/Management Company Phone *

Landlord/Management Company Email Address *

How did you hear about us?

What size dog(s) are you willing/able to foster? *

SmallMediumLargeX-Large

What energy level are you willing/able to foster? *

Couch PotatoMildEnergeticMarathon Runner

Why are you interested in fostering? *

How will the foster dog get exercise/play? *

Do you have a fenced-in yard? *YesNo

Where will the foster dog stay when you are away from home? *CratedConfined area of the homeLoose in the homeOutside

What is the maximum amount of time the foster dog will stay home alone? *

Are there any pets in the house that belong to someone else? *YesNo

Have you owned any pets in the past 10 years? *YesNoPlease include pets in the house that do not belong to you.

Please list all pets owned in the past 10 years and where they are now: *Please include pets that live in the home but do not belong to you.

Are all pets in the house spayed/neutered? *YesNo

Please explain why all pets in the house are not spayed/neutered. *

Are all pets up-to-date on the following:

Are all pets in the home up-to-date on DHPP Vaccination? *YesNo

Are all pets in the home up-to-date on the Rabies Vaccination? *YesNo

Are all pets in the home up-to-date on Bordetella Vaccination? *YesNo

Are all pets in the home up-to-date on Heartworm Preventative? *YesNo

Are all pets in the home up-to-date on Flea/Tick Preventative: *YesNo

Please explain why your pet(s) is/are not up-to-date on all of the above: *

Please provide contact information for the veterinarian who has seen your pets:

Clinic Name *

Phone *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Please note, references shall not be related by blood or marriage nor shall they reside in the same household as the applicant(s).

Reference #1

Name *

Phone *

Email Address *

Relation: *

Best time to contact: *

Name *

Date *