Foster Application Form Name* First Last Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Cell PhoneHome PhoneEmail* Preferred method for contacting you: Cell Phone Home Phone Email OCCUPATION:*Job TitleCompany NameHow many hours are you away from the house on a given day? Are you 21 years of age or older:* Yes No Type of home you live in:* House Condo/Townhouse Trailer home Apartment Do you rent or own your own home:* Own Rent If you rent or are a roommate, please profide the landlord's name and phone number.Do you have a fenced yard:* Yes No Number of people living in the home:*Number of people under 18 years old:*If children under 18, list their ages:Does anyone living in the home have allergies:* Yes No Have you been a foster home before:* Yes No Do you have pets living in your home now:* Yes, dogs Yes, cats Yes, other pet No Are all your pets current on vaccinations:* Yes No Current pets*Name of PetBreedAgeSexSpayed/Neutered (YES/NO) Is there a particular dog that you are interested in fostering? (Please list the name)List size, breed and qualities in a dog that would best suit your home:List size, breed and qualities in a dog that would NOT suit your home:How long will you be able to provide a foster home for a dog:* Forever 6 months - year Several months Emergency foster only (1-2 weeks) PERSONAL REFERENCES:Please provide contact information for 3 personal references. Someone that knows and can provide insight on your character, how you feel about pets, how you treat pets, etc. (Neighbors, friends, co-workers etc) These references cannot be family or live in your home. with you.Name of First Reference* First Last Phone*Email* Relationship to you:*Name of Second Reference* First Last Phone*Email* Relationship to you:*Name of Third Reference* First Last Phone*Email* Relationship to you:*Veterinarian Practice Name*Name of Vet:* First Last Phone*I have answered all questions and provided all needed references truthfully and honestly to the best of my knowledge. I will do my best to comply with House with a Heart's Foster Home Requirements, which included providing a loving and safe environment for my foster dog.*Please initial: This iframe contains the logic required to handle AJAX powered Gravity Forms.