Name(s):
Address:
City:
County:
State:
Zip:
Phone:
(Home)
(Work)
(ext.)
(Cell)
Email
address:
How
long have you lived at this address?
If
less than 6 months, please list previous address and
landlord:
Address:
City:
State:
Zip:
Landlords
Name(s):
Are
you planning on
moving in the next 6 months?
Yes
No
Do
you live in
a:
House
Apartment
Moblie
Home
Condo
Dormitory
Do
you own or
rent?
Own
Rent
If
you rent, please list
your landlord's name and phone
number.
Have
you adopted from
this S.P.C.A before?
Yes
No
If
you've adopted from
us in the past, how long ago was
it?
Please
list your place
of employment and the phone number:
Phone
number in case of
an emergency:
Reference 1:
Reference 2:
Reference 3:
What hours
are you
usually at home?
Ages
of any children
living in your home:
Can
we visit your
home?
Yes
No
Where
will your pet
spend most of it's time?
Outside
Inside
If
outside, how will
your pet recieve exercise?
Walks
Chain
Dog
Run
Fenced
Yard
If
outside, what type of
pet housing do you have?
Will
this be your first
pet?
Yes
No
What
type of pets did
you previously own?
Cats
Dogs
Both
How
many dogs do you
have now, and what are their names?
How
many cats do you
have now, and what are their names?
Do
you have any pets
other than cats and dogs? If so, what?
If
you do not currently
have pets, how long has it been since you last had a pet?
If
you have Animals now,
are they spayed or neutered?
Yes
No
Where
do your current
pets spend most of their time?
Inside
Outside
Please
state your
veterinarians name:
Please
state your
veterinarians phone number (include area code please):
Do
you have an area
where the foster pet
can be isolated for housebreaking or health puproses?
Yes
No
I certify that the
information given by me in this application
is true and complete. I further understand that any falsified
information
that I give will terminate the action on the foster process. I hearby
authorize release/disclosure of records and/or other information
concerning
all of the above inquiries, including but not limited to employment
information,
tenancy information and veterinarian records. The Cumberland County
S.P.C.A
reserves the right to refuse any foster home it considers
unsatisfactory.
By
clicking the
submittion button below, you agree to
the above stated contract, and confirm that all information provided is
the truth to the best of your knowledge. You also agree that this
submittion
will be as valid and binding as an actual signature, and upon approval
to foster that you will sign the above form in a printed format
while
being witnissed by an S.P.C.A Representative without modification or
editing.
