Northern Animal Rescue Foster Care Application Form

First Name:

Last Name:

Email:

Phone Number:

Address:

Do you rent or own your dwelling?

Rent

Own

Name and Phone Number of Landlord/Rental Agency: Landlord approval must be received prior to any fostering of animals.

PLEASE ANSWER ALL OF THE FOLLOWING QUESTIONS:

1. Do you have any pets of your own?

Yes

No

2. If yes, what kind and how many?

3. Are they spayed/neutered?

Yes

No

4. Are they vaccinated?

Yes

No

5. Who is your veterinarian?

6. Has any cat in your home had calicivirus, rhino or feline leukemia?

Yes

No

7. Has any dog in your home had parvovirus or distemper?

Yes

No

8. What type of animal do you prefer to foster?

Cats

Dogs

Both

9. Do you or anyone in your home have any allergies that would be affected by the animals that you would foster?

Yes

No

10. Have you ever had experience in raising puppies or kittens before?

Yes

No

11. How much time are you able to spend with the animal(s) and who will be home to supervise this (these) animal(s)?

12. Where will the animal(s) be kept during times of non-supervision?

13. Do you have a separate room or a quiet area where you can separate the foster animal(s) from your own pet(s)?

Yes

No

14. Are you aware of the animal control bylaws in the Town of La Ronge or Village of Air Ronge?

Yes

No

If yes, what are they?

15. Where will the animal(s) sleep?

Indoors

Outdoors

16. Do you own a dog kennel/crate or cat carrier?

Yes

No

17. Have you ever kennel trained/house broken a dog/puppy?

Yes

No

18. What provisions have been made for outdoor shelter?

19. How will the animal(s) be secured outdoors?

20. Do you have a fenced yard?

Yes

No

21. Does everyone in the family want to participate in the program?

Yes

No

22. Number of adults and children in the home?

23. Will you and your family consent to home visits prior to and during the fostering period?

Yes

No

Please describe your knowledge, experience and abilities in the care and training of dogs/cats to assist us in identifying appropriate placement of the animals that will benefit through our Foster Care Program.

Additional Comments:

Signature

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Year

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