Application to Foster or Adopt

Which role are you applying for?

Foster Adopter

I am looking to foster ... *

Dog Cat Either

Which pet are you specifically interested in?

If applicable

Please indicate the type(s) of foster you would like to be: *

Finder-turned-Foster (You found a dog and are willing to foster for an indefinite period of time) Full Foster (You are available to foster a dog for East CAN long-term) Foster for a Foster (Short term. You are available to foster, but only for limited time-frames) Emergency Foster (You can house a dog for 1-3 days in an emergency situation)

What qualities are you looking for in a dog? (Please check all that apply)

Protection Companionship Company for another pet Apartment living Hiking/Walking Outdoor activities Gift for someone Hunting

What size pet are you most comfortable with?

What age range of pet are you most comfortable with?

Would you accept a special-needs animal (i.e. deaf, senior, blind, hospice care)?

Yes No

Is there a breed, size or type of dog that you absolutely will not accept?

Yes No

If yes, please describe and explain.

Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Email *

example@example.com

Home Phone *

Area Code Phone Number

Cell Number

Area Code Phone Number

Work Number

Area Code Phone Number

Best way to reach you and when? *

Have all the adults in the household agreed to welcome this dog to your family? *

Yes No

List all people living in the household (include name, relationship, gender and age) *

List any pets you currently have living in your household (dog, cat, rabbit, bird, etc.) Please include name, species/breed, age, gender and where they are housed.

If applicable above, indicate which, if any of these pets are unaltered, not vaccinated or not on heartworm preventative.

If you currently have more than one dog, please describe the pack dynamic.

Where do you currently reside? *

House Apartment Condo Mobile Home Duplex Parents' Home

How long have you lived in this residence? *

Do you Own or Rent? *

Own Rent

If you rent, list your landlord's name and contact information.

If you live in a complex or rent, does your lease or HOA allow animals?

Yes No

If restrictions apply, provide specifics (i.e. number of animals, weight limits)

Is anyone in the household allergic to pets or have asthma? *

Yes No

If known allergies or asthma exist, please elaborate.

Who will be responsible for caring for this dog? *

Do you as the applicant accept full responsibility for the continuous proper feeding, watering, housing and leashing of this animal? *

Yes No

How much time will the dog spend outside unsupervised? *

0 - 25% 26 - 50% 51 - 75% 76 - 100%

How will you keep the dog confined to your property? *

Fence Other

If fenced, indicate the fence height and type. If other, please elaborate. *

Do you plan to move in the near future? *

Yes No

If yes, when are you moving and where?

If at a future time, you move to a property that does not accept pets, what will you do with this pet? *

What will you do with your pet when you travel? *

Where will the dog stay when you are home? *

Where will the dog stay when you are out of the house? *

Please describe your typical schedule with respect to when you are home vs away. How much time will the animal regularly spend alone? *

Are you prepared to allow the animal a minimum of two weeks to adjust to its new home? *

Yes No

If your pet becomes suddenly ill, are you willing and able to afford a bill of $100-$400+ for emergency veterinary care? *

Yes No

Are you willing to treat a lifelong medical condition if it developed? *

Yes No

Are you willing and able to dispense monthly preventative medications (i.e. heartworm)? *

Yes No

If the foster animal becomes suddenly ill or injured, are you able to manage veterinary visits and after-care? (not financial responsibility) *

Yes No

Are you willing to dispense scheduled medications, if necessary? *

Yes No

Do you agree to scheduled walks with the dog (separate from playtime and regardless of having a fenced yard)? *

Yes No

Do you have any known travel plans that would require East CAN to coordinate alternative care for the foster dog in your absence? *

Yes No

If travel plans exist, please indicate when and for how long. *

What would cause you to be unable to care for this dog any longer? *

Have you owned any pets in the last five years that you no longer own? *

Yes No

If yes, please elaborate on each, including species/breed, where the animal was housed and why you no longer own this animal.

If you currently have or have had a pet in the recent past, please provide your current and past veterinarians' contact information.

Current Vet Name

First Name Last Name

Phone Number

Area Code Phone Number

Past Vet Name

First Name Last Name

Phone Number

Area Code Phone Number

How did you find out about East CAN?

www.eastcan.org Petfinder Adopt-a-Pet Facebook Instagram Community Event Family/Friend

Is there anything else you want us to know, including information you did not have room for above?

Please provide three non-family references who can speak about your capacity to love and care for an animal (i.e. vet, pastor, neighbor, friend).

Reference #1 *

First Name Last Name

Phone Number

Area Code Phone Number

Email

example@example.com

Relationship to you

Reference #2 *

First Name Last Name

Phone Number

Area Code Phone Number

Email

example@example.com

Relationship to you

Reference #3 *

First Name Last Name

Phone Number

Area Code Phone Number

Email

example@example.com

Relationship to you

Mark each box to indicate that you have read and accepted each statement. *

East CAN reserves the right to refuse placement to any applicant for any reason. This questionaire becomes part of our contract.

By electronically signing and submitting this application, you are confirming that the information given in this form is true, complete and accurate.

Signature *

Full Name *

First Name Last Name

Date *

Date

Application to Foster or Adopt

Contact Information

Environment

Pet Care

Other Information

References

Agreement