Foster Questionnaire

Name(Required)

First Last

M.I.

DOB(Required)

Address(Required)

City(Required)

US States(Required)

Zip(Required)

Home Phone

Cell Phone(Required)

Email(Required)

List all members over the age of 18 of your household:
All family members will be required to meet with foster pet prior to going home.

1st Family Member over 18(Required)

DOB(Required)

2nd Family Member over 18

DOB

3rd Family Member over 18

DOB

List all members over the age of 18 of your household(Required)

All Family members will be required to meet with foster pet prior to going home

Are you interested in fostering:(Required)

Dogs/Puppies

Cats/Kittens

Both

Please list all pets you currently own(Required)

For each pet, please include:

Name & Age
Kind/Breed
Spayed or Neutered?
Can you provide proof that vaccinations are up to date?

Do you have a fenced yard?

Yes

Do you have any questions/concerns about fostering with Humane Fort Wayne?

As part of the application process Humane Fort Wayne will conduct a criminal background check for any domestic or animal abuse.

I certify that my answers are true and complete to the best of my knowledge, and I authorize investigation of all statements contained in this application. I understand that omission or misrepresentation of facts called for is cause for denial of fostering animals. Humane Fort Wayne reserves the right to refuse any foster care applicant. My signature allows release of any information necessary to process this application.

Signature

Date

MM/DD/YYYY

Foster Questionnaire

Hours & Locations