BARC Foster Parent Application
If you have any questions you may call Barb Sherman at 815-383-2087 or bgs82@sbcglobal.net.
Today's Date
*
-
Month
-
Day
Year
Date Picker Icon
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Tell us about yourself:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Home Phone Number
*
-
Area Code
Phone Number
Cell Phone Number
-
Area Code
Phone Number
E-mail
*
List All Household Members and Ages:
*
Number of Current Animals residing in the home:
Enter a number for each type and use the comments field to add any detail you would like us to know.
Canine
*
Feline
*
Other
*
Comments
Back
Next
Additional Information
Previous or Current Experience with Fostering Animals:
*
What types of dog are you interested in fostering? (i.e. Injured, timid,young, old, etc.) Are there any issues you would NOT feelcomfortable fostering?
*
Do you have a fenced-in yard?
*
Yes
No
Do you work outside of the home, what are your hours if you do so?
How many hours will the puppy/dog be left alone daily?
Where will the puppy/dog be when left alone?
Where will the puppy/dog sleep?
Have you housetrained a puppy/dog before?
Do you have stairs the puppy/dog will have to go up and down?
References
Please list two references with phone numbers that we may contact who can attest to your ability to fulfill fostering requirements: (one reference needs to be a veterinarian). The second is a drop-down list, please choose the most appropriate description.
Full Name Ref #1
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Relationship
*
Veterinarian
Friend
Relative
Other
Full Name Ref #2 - Veterinarian
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Relationship
*
Veterinarian
Reference Check
It will be necessary to check vet references and if possible, conduct a home visit. If a home visit is not possible, the BARC board may ask for pictures of areas the foster BMD will be kept and rehabilitated.
Electronic Signature
By typing your name in this box, and submitting to BARC, you are submitting, and BARC is accepting, your legal signature.
Electronic Signature of Potential Foster Parent
First Name
Last Name
Date
-
Month
-
Day
Year
Date Picker Icon
Submit Application
Should be Empty: