| Full Name:* |
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| Address (Include city, state and zip):* |
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| Housing:* |
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| Do you rent or own?* |
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| Private yard: |
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| Fenced: |
Height: |
| If rented: |
| Landlord Name: |
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| Phone Number: |
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| Primary Phone:* |
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| Secondary Phone: |
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| Email: |
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| Age - Over 21:* |
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You would consider fostering:
(Hold 'CTRL' or 'CMD' key for multiple selections) |
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| Do you or your landlord have any specific requirements and/or restrictions? |
| Weight: Age: Breed: |
| Do you have experience with giving: |
| Oral Meds: Injectable Meds: |
| Bottle Feeds: Syringe Feeds: |
| Are you able to feed a specific diet without allowing access to other foods? |
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| How long would you be willing to foster for? |
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| When would you be able to take in a foster pet? |
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| Do you have prior foster care experience? |
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| If Yes: |
| Where: |
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| When: |
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| Doing: |
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| Your work hours: |
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| Reference #1:* |
| Name: |
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| Phone Number: |
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| Relationship: |
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| Reference #2:* |
| Name: |
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| Phone Number: |
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| Relationship: |
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| Are there children under 21 living in the household? |
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| Please list all children under 21 living in the household and their ages: |
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| Please list all adults over 21 living in the household, ages and phone numbers: |
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| Are the above people aware of your application to foster: |
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| Do you have any other pets living in the household?* |
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| Please list all animals living in the household; their ages and breeds: |
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Are the animals living in the household good with:
(Hold 'CTRL' or 'CMD' key for multiple selections) |
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| Are the animals living in the household up to date on vaccines? |
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| If no, why is the pet not getting vaccinated? |
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| Are the animals living in the household spayed or neutered: |
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| If no, why is the pet not spayed or neutered? |
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| Veterinarian: |
| Name: |
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| Phone Number: |
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| If no vet; why? |
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| Previous animal experience: |
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| Are you able to keep the foster care pet separate from other pet(s) at home?* |
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| Where, specifically, will the foster care pet be kept: |
| During 1st two weeks: |
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| After 1st two weeks: |
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| Have you or anyone in your household ever applied to adopt from NSALA?* |
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| If so what happened? |
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| If you adopted from NSAL: |
| When: |
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| Where is pet now? |
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516.883.7575