West TN Animal Rescue Foster Care Application
Name or Pet ID:
Title:	Mr. Mrs. Miss. Ms. Dr.
*First Name:
*Last Name:
Suffix:	CEO CLU CPA DC DDS DO DVM I II III IV Jr. MD OD PHD PharmD RN Sr. V VI
*Address:
*City:	*State: *Zip:
*Best Contact Number	(xxx-xxx-xxxx)
Alternate Phone:
*E-Mail Address:
*Verify E-Mail:

Companion Animals
In the table below please list all companion animals you currently have at your home. If more than 6, list them in the Additional Comments section. (Altered = Spayed or Neutered)
Name	Age	Breed	Gender	Altered	What/When happened to this pet?
			FemaleMale	YesNo
			FemaleMale	YesNo
			FemaleMale	YesNo
			FemaleMale	YesNo
			FemaleMale	YesNo
			FemaleMale	YesNo

Additional Questions

Please check all that apply.
	I am at least 21 years of age.
	I have never been convicted or officially accused of a crime against an animal.
	I currently or have previously fostered for (Enter Name)
	I was referred by: (Enter Name)

* List any rescue groups or animal welfare groups you are associated with or have fostered for in the past.
* Please list all people living in the house and/or who will have regular contact with your animal(s), including their ages.
* Do you own your home or rent your home?
* Do you have a fenced-in yard? If yes, please describe type of fencing, approximate size of the fenced area, and locking mechanism on the gate.
* Where do/will your animals stay during the day when you are home and how long are they left alone?
* Where do/will your animals stay during the day when you are not home?
* Where do/will your animals sleep at night?
* Do you or have you ever bred animals? If yes, please explain.
* How do you plan to introduce your new foster pet to your current pets?
* How will you keep your pets separated if necessary?
* Are your pets altered and up to date on vaccines (parvo/distemper, rabies, bordetella)?
* Are you willing to incur the cost of feeding your foster pet a quality food while in your care?

References
Veterinarian References:
Please list your primary vet and secondary if needed. If more than two veterinarians treat your pets please list them in Additional Comments.
Primary Vet:
Name on Account:
*Practice Name:
*Address:
*City:	*State: *Zip:
*Phone with area code:	(xxx-xxx-xxxx)
*Animals treated by this vet:
Contact Person:
Secondary Vet:
Name on Account:
Practice Name:
Address:
City:	State: Zip:
Phone with area code:	(xxx-xxx-xxxx)
Animals treated by this vet:
Contact Person:
Personal References:
Please list 2 people other than family members as references. They must be people who know you and your companion animals and have been to your home.
Reference 1
*First Name:
*Last Name:
*Address:
*City:	*State: *Zip:
*Phone with area code:	(xxx-xxx-xxxx)
Reference 2
*First Name:
*Last Name:
*Address:
*City:	*State: *Zip:
*Phone with area code:	(xxx-xxx-xxxx)
Employer:(or business, if self-employed)
*Employer Name:
*Address:
*City:	*State: *Zip:
*Phone with area code:	(xxx-xxx-xxxx)
Landlord(if you do not own your home)
If you are currently renting please provide landlord name and best phone number to reach him/her.
Landlord Name:
Landlord Phone:

Additional Comments
Please provide any additional information relevant to this application.

Acknowledgment
	By submitting this Foster Care Application, I am granting permission for a West TN Animal Rescue representative to contact my veterinarian/s, landlord (if applicable), and listed references with the intent of gaining personal information about my lifestyle and the care of my existing and previous animals. I am also granting permission for a West TN Animal Rescue representative to conduct an inspection of my home at a scheduled time.
	I understand that if my application is approved, it will represent the legal contract between myself and West TN Animal Rescue.
	I have read this application in its entirety, and I agree that all statements contained in this document are made by me, and are truthful. I make this statement under penalty of perjury under the laws of the state of Tennessee.
*I agree with the above terms.
I Do Not agree with the above terms.