Name *

First Name

Last Name

I am at least 19 years old *

Yes

No

Phone Number *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Agreeable to home visit? *

Yes

No

Is anyone in your household allergic to cats/dogs? *

Yes

No

Do you live in a: *

House

Apartment

Mobile Home

Other

Do you rent or own? *

Rent

Own

If you rent, is your landlord agreeable to you fostering a large dog? (You will need to provide a letter stating you have permission to keep a dog over 50 pounds.) *

Yes

No

I do not rent

Landlord's Name *

If you own please put N/A

First Name

Last Name

Landlord's Phone Number

(###)

###

####

Is your yard completely fenced? *

Yes

No

Are your children used to being around cats/dogs? *

Yes

No

Are you willing to foster for a long term or extended time frame if required? *

Yes

No

Baldwin Humane Society issues medical vouchers for care for foster cats/dogs. Are you willing to take the foster dog to 1 of our 29 participating Vets for authorized medical care? *

Yes

No

I acknowledge the inherent risks in rescuing and handling dogs and cats, and I assume that risk by accepting a foster animal in to my home. *

Yes

No

I give my consent to the Baldwin Humane Society to contact with the listed references. Any information obtained by Baldwin Humane Society will remain confidential. *

Yes

No