Foster Care Application and Agreement Name * First Name Last Name Email * Primary Phone * (###) ### #### Home Phone (###) ### #### Work Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Is this address * Permanent Seasonal If seasonal when are you in Arizona? Do you * Own Rent Do you have an HOA? * Yes No If so, what is the limit of how many animals you may have Are there children in your home? * Yes No If yes how many What ages Do you currently have pets? * Yes No Number of cats Number of dogs Are your dogs licensed? Yes No other pets Are they current on rabies vaccinations * Yes No Are they current on all other vaccinations * Yes No Any diseases your household pets may have/had Parvo Distemper Feline Leukemia FIV Other If other, which diseases Do you have a doggie door? * Yes No What do you prefer to care for * (please check all that apply) Adult Cats Kittens Nursing Mom with Kittens Are you willing to foster a kitty that needs training? * Yes No Are you willing to foster a kitty with medical issues? * Yes No Are you willing to foster a kitty that requires medication? * Yes No If yes, please detail your prior experience with administering medications Would you foster multiple kitties? * Yes No If so how many Will your foster kitty/kitties be housed separately from owned animals? * How many hours a day will your foster kitty/kitties be left alone? * What enrichment activities will the foster kitty/kitties receive? * Are you willing to foster a kitty or litter until it/they are adopted? * Yes No Consent I have read, understand, and agree to the attached Foster Terms and Conditions * Agree Electronic Signature Consent * By electronically signing any document related to Safe Haven for Animals, you acknowledge and agree that your electronic signature carries the same legal effect as a handwritten signature. You consent to conduct transactions electronically and understand that all records, agreements, and communications in electronic form are legally binding. Safe Haven for Animals reserves the right to request physical signatures if necessary. Agree Foster Care Provider Signature * electronic signature Date MM DD YYYY Thank you! Terms and Conditions
