Name: *

Address: *

DL State and Number *

Home Phone: *

Work/Cell Phone: *

Email Address: *

How did you hear about us? *

How many Adults over the age of 21 (including self) and ages: *

Children (under 21) and ages: *

Does anyone in the household have allergies to dogs? *

Do you live in: *

Do you: *

If Rent or lease, please provide Landlords Name and Phone Number.

If renting or leasing , Are their Breed restrictions? If yes, what are they. *

How long at your current address? *

Veterinarian Reference: Name and Phone Number *

Please list all of your current pets Include.... Name, Age, Breed, Sex, Dog or Cat, Alter Status and How long you have owned. *

Who will be the primary care taker of your foster dog(s)?

How would you describe your level of experience with dogs? Check all that apply *

Do you have experience with: *

List experience with specific breeds: *

What types of dog(s) are you interested in fostering? Check all that apply *

How many hours during the AVERAGE day will this dog spend WITHOUT a human *

Where will the dog be left when no one is home? *

Where will this dog sleep? *

What situations do you feel unprepared for? *

Size Preference? If yes please state preference *

Breed Preference? If yes please list *

Age Preference? If yes please state. *

Please tell us anything else you would like to know to help match you up with the right foster animal: *

PITPH determines the criteria for fostering, decides which animals are eligible for foster care, and appoints foster caregivers from a pre-approved list of trained providers. PITPH will require you to go fill out a foster application prior to being accepted as a foster parent. PITPH foster care volunteers may always refuse any specific request for any reason. PITPH staff will inform you of any medical treatments to be administered, the anticipated length of the foster care period, the objectives of each particular placement (restoring to health, rearing to adoptable age, socialization, etc.), and any other restrictions or expectations we may have.You will be expected to keep the animal safe and secure, return it to PITPH when requested to do so, and not promise the animal to anyone, or imply that you have the authority to approve a potential adoption. PITPH retains ownership of all animals placed in foster care, and will make all decisions regarding the adoption & placement of the animals fostered. You are also not allowed to change the names of the animals. PITPH does not accept into this program those convicted of violent crimes or crimes involving animal cruelty or neglect.Unless otherwise arranged, the foster parent is not responsible for providing all food, litter, bedding, and toys for the animal while it is in their care at home. PITPH will transport if needed for veterinary appointments, surgery, behavior evaluations, vaccinations, etc. PITPH needs to be made aware of any concerns regarding the foster animal. PITPH will schedule an appointment with our veterinarian and/or give instructions for emergency vetting.I have read and understand the statements above. I certify that all the information contained in this application is true and correct. I understand that although PITPH takes reasonable care to screen animals for foster care placement, it makes no guarantees relating to the animals' health, behavior or actions. I understand that I receive foster care animals at my own risk and can decline to accept any animal for which PITPH has asked me to provide care to. I acknowledge that PITPH is not responsible for any property damage or personal injury suffered by me, members of my household, including my own animals, or any third parties during a foster placement, and I assume liability to provide adequate controls to prevent such damage or injury. *