BARC Foster Parent Application

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*

MonthDay Year Hour Minutes 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 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

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?*

YesNo
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*
Full Name Ref #2 - Veterinarian*

First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
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

MonthDay Year
Should be Empty:

Additional Information