Foster Volunteer Application Legal Name* First Middle Last Are you over the age of 21?*YesNoDate Of Birth*Example: 01/22/1978Cell Phone*Your Email* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is your home address where the pet will live?YesNoDo you work outside of the home?YesNoSpouse/Partner* First Middle Last Spouse/Partner's Date Of Birth*Example: 01/22/1978Spouse/ Partner's Cell Phone*Spouse/ Partner’s Email Spouse/Partner employment information:Employers Name:Address:Employers Number:How long have you worked there?Employer Name*How long have you worked there?*Employer Number*Are you willing to have a Last Chance representative conduct a home visit?YesNoWhy would you like to participate in this program?*Type of animal(s) you are willing to foster:*Are you a first time pet owner?*YesNoPlease list any animals in your home in the past 10 years current and past*Please include the name, species, sex, if they are spayed or neutered, and the age.How many hours are your pets alone?*How are they kept when you are away?*Who will supervise ALL outdoor activities?*Are your pets good with other animals?*If you have cats, do you keep them indoors or do you let them outside?IndoorOutdoorBothIf you have dogs, do you keep them primarily indoors or outside?IndoorOutdoorBothYour Veterinarian’s Name & Address*Veterinarian’s Phone Number:*May we contact them for a vet reference?YesNo*Please contact your vet and give them permission to release information to a Last Chance Representative.Please indicate your housing status Rent an apartment Rent a house Own a house or condo Live with parentsCONTACT INFORMATION (if living with parents)If you are renting, please provide your landlord’s name and number:Do you have a fenced yard?*YesNoIf no, how the pet will be exercised?Type of FenceHeight of FenceDo you have a Pool? Yes No If yes, is it fenced?How many members in your household?Adults:Kids/Ages:Please list two (NON-RELATED) personal references that we may contact:Personal reference #1:*Telephone number:*Your relationship:*Personal reference #2:*Telephone number:*Your relationship:*How did you hear about Last Chance’s Foster Program?*PLEASE FILL OUT THIS NEXT PORTION IF YOU MAY WANT TO ADOPTOur rescue animals make wonderful pets and usually adjust quickly to their new families. To create great outcomes, we foster animals with members of our group, council adoptive families and make recommendations that help our adopters to make the right decision for themselves and their new pet. We require a $400 adoption donation from all adoptive families at time of adoption to help cover the cost of preparing the dog for his/her new home. We spay/neuter all animals prior to adoption. LCAR is a non-profit animal rescue organization that rescues from animal shelters; as such Last Chance Animal Rescue cannot and does not warranty the health or breed of the animal. Please fill out the application to help us get to know you, your family and your lifestyle. This information will assist us in matching you with one of the rescue pets awaiting adoption. A $400* non-refundable ADOPTION FEE includes:All animals spayed / neuteredVaccines up to dateDewormedHeartworm tested, pups 6 months and olderCurrent on heartworm preventative, if old enoughFlea/tick control appliedBoarding and transportation from sheltersMicrochip *Limited ability to take credit cards, no checksAre all adults in the household aware that you are adopting a dog and in agreement?YesNoAre you expecting?YesNoAre any members of your household or regular visitors allergic to dogs?YesNoDo children visit frequently?YesNoHave you ever lost a pet (i.e. ran away, stolen, hit by a car)?Have you ever turned a pet into the shelter? If so, please explain:If you move, what will you do with your pet?Is there a situation in which you would not be willing to keep your pet?When you go on vacation/travel, who will care for your pet?Are you willing to take care of your pet for 10 or more years?Are you prepared for the effort in house training a dog?YesNoDo you know how to crate train?YesNoHow long do you expect house training to take?Do you understand the importance of socialization?YesNoAre you planning on attending training classes with your dog?YesNoDo you understand the importance of obedience training?YesNoHow long are you willing to give your new pet to adjust to his/her new home?Do you have an idea of the yearly expense of caring for this animal? Please provide an estimate (vet care, food, grooming, licensing):How much are you willing to spend on medical bills for your pet?What will you do if your bills go over your budgeted amount?Do you understand the importance of heartworm and flea and tick preventative?YesNoWhat behaviors WOULD you be willing to work through with training? (If you have children under the age of 14, please give particular thought before answering)All animals we adopt out are spayed/neutered; Do you have and reservations about that?YesNoThe adoption contract stipulates that should you not be able to care for your Last Chance pet that you will return it to our rescue for re-homing. Do you have any reservations about that?YesNoPlease add any additional comments below:I acknowledge that all the information on this form is true and correct. I understand that any misrepresentation of any fact may result in the removal of the animal from my home by Last Chance Animal Rescue Inc.(Type name to sign)Date Date Format: MM slash DD slash YYYY
