Name:

Address:

City/State/Zip:

Home Phone:

Work Phone:

Cell Phone:

Email:

Type of residence: Select one House Apartment Mobile Home

Do you: Own or rent? Own Rent

If you rent, we will need to verify your landlord’s pet policy.  Please provide your landlord’s name and phone number:
Landlord name & phone #

Do any members of your household suffer from allergies? 
Yes No

How many people live in your home? 
# adults: # children:

Who will be responsible for the care of the animal?


Do all home members agree to fostering an animal?

Why do you want to foster an animal?

Where do you plan to keep your foster animals?

Where will the animal be confined during your absence?

Do you have a fenced in yard?  yes no
If yes, type & size of fence:

Are you capable of giving medication to a foster animal if necessary?
yes no

Are you able to keep any household pets separate from foster animals, if necessary?
yes no

If necessary, can you transport a sick or injured foster animal to a veterinarian?
yes no

Are you prepared to take the animal to a twenty-four hour veterinary clinic after business hours in the event of a medical emergency?
yes no

Do you understand that the animals in your care will be available for adoption through “Pet Finder,” LHS website, PetSmart Adoption Outings, and other media sources?
yes no

Are you willing to take your foster animal to PetSmart Adoption Outings?
yes no

Are you willing to set up meeting times for potential adopters in your home?
yes no

How long are you able to foster an animal?

Have you or anyone in your household ever been convicted of any animal related misdemeanor or felony offense?
yes no

What other animals do you have at home?
Dog 1: Name/Breed/Age/Gender
Spayed/Neutered? yes no

Dog 2: Name/Breed/Age/Gender
Spayed/Neutered? yes no

Dog 3: Name/Breed/Age/Gender
Spayed/Neutered? yes no

Dog 4: Name/Breed/Age/Gender
Spayed/Neutered? yes no

Cat 1: Name/Breed/Age/Gender
Spayed/Neutered? yes no

Cat 2: Name/Breed/Age/Gender
Spayed/Neutered? yes no

Cat 3: Name/Breed/Age/Gender
Spayed/Neutered? yes no

Cat 4: Name/Breed/Age/Gender
Spayed/Neutered? yes no

Are all your animals up-to-date on all vaccinations, rabies shot, on flea/tick treatment, and on heartworm preventative?
yes no

Do you object to a LHS representative coming to your home to check on the animal while it is in your care?
yes no

PET’S HEALTH AND DISPOSITION

LHS provides regular vet checkups and keep all our animals up-to-date on all vaccinations, heartworm preventative, flea/tick treatment and any necessary medical attention.  We also do extensive temperament testing.  However, the LHS cannot guarantee the health or disposition of any foster animals.  We do not have past health records for these animals and there is some risk associated with taking in foster animals.  Family pets should be current on all shots.

EXPENSES

Because of limited funds, the LHS cannot always provide food, toys and litter for all the foster animals, when we have donations or adequate monies we are more than happy to pass along the bounty to our foster families.  However, all medical care and treatment is completely paid for by LHS, if using LHS participating vets (provided at time of approval).   We can and do provide dog crates and cat carriers.

TRANSFER OF ANIMALS

ADOPTION

Foster parents can adopt a foster animal if you choose to do so at a reduced rate of 50%.  Foster parents are always encouraged to find prospective owners for their foster animals.  Prospective adopters must meet LHS’s adoption criteria and a LHS adoption contract completed.

RETURN OF ANIMALS

All the animals that you foster for the LHS must be returned to us should you not be able to continue to care for the animal.  Please be advised that there may be a brief waiting period to find another foster home (we have no facility and rely on our volunteer foster parents) or room made at our medical waystation. 

This portion will be provided to you for your signature when you receive your foster animal: