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Sample Foster form

APPLICATION & AGREEMENT FOR FOSTER CARE PROVIDER #1

 

Date Saturday, January 26, 2013
Name Don Mertes
Home Number (602) 795-2260
Cell Number (602) 919-8471
Work Number (602) 795-2260
Email donmertes1@cox.net
Address  

1509 East Granada Road
Phoenix, AZ 85006
United States
Is this address: Permanent
If seasonal, when are you in the Phoenix area?
About your home: I own my home
If there are child living in your household, what are their ages: No children
Which do you prefer to care for (please check all that apply): Adult Dogs
Do you have any experience with suckling’s that need to be bottle fed?
If so, please explain
Yes, and I never want to do it again!
Do you currently have pets?
  • Yes
Are they Spayed/Neutered?
  • Yes
Number of Cats 1
Number of Dogs 7
Other 1 Parrot and 1 Chicken
Are they current on rabies vaccination(s)?
  • Yes
Are they current on booster(s)?
  • Yes
Are your dogs licensed?
  • Yes
Please check any diseases your household pets may have or had:
Other diseases or illnesses None
If you have had dog and/or cat diseases in your home, please list when: n/a
Do you have an enclosed outdoor area?
  • Yes
How high is the barrier? 6 foot block wall
Where will your foster animal(s) be housed? Indoors with the rest of my pets
How long will you be able to foster an animal or litter? indefinitely

 

Created

26 Jan 2013

12:04:16 PM PUBLIC

68.2.194.12

IP Address

Updated

26 Jan 2013

12:06:16 PM PUBLIC

 

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