First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Cell Phone*

Pet's Name:*

Your Age?*

Please provide your driver's license number.*

Please provide your license plate number*

Your Occupation?*

Spouse/Roommate Name:*

In what type of home do you live?*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home?*
Choose one: Rent Own

If you rent, please enter your landlord's name and phone number.

What type of dog are you interested in fostering? Male or female? Age? Size?*

Who will be the person responsible for the daily care of the pet, such as feeding and exercise?*

How many people reside in your household?*

Are there any children living in the household?*
Choose one: Yes No

If so, what are their ages?

Please describe your household:*
Choose one: Active Average Noisy Quiet

Do you know if you or anyone living in the household is allergic to the pet you are planning to adopt?*
Choose one: Yes No

If you discover someone living in the household is allergic or develops allergies the pet, are you willing to spend additional money on allergy medications?*
Choose one: Yes No

What other pets do you have (specify type, size and number)?*

Are these pets up to date on vaccines?*
Choose one: Yes No

Spayed/Neutered?
Choose one: Yes No

If no, why not?

Have you ever given up a pet? If yes, please explain*

Describe how you will train the pet:*

List at least one personal reference (who is not a family member). Please include their name, address, phone number, email and how many years known.*

Veterinarian's Name, Address and Phone Number. Please call your vet to give them permission to speak with us.*

How many hours a day will the pet be left alone?*

Will the animal be kept inside or outside?*
Choose one: Inside Only Outside Only Inside and Outside

Where will the animal be kept when you are not home?*

Where will the animal be kept when you are home?*

Where will the animal sleep?*

Is your yard fenced?*
Choose one: Yes No

If not, how will you confine the pet to your property?*

What is the height of the fence?

What type of fence do you have?*
Choose one: Privacy Chain Link Invisible None

Do you agree to contact Harter's Hospice Rescue if you can no longer keep this foster?*
Choose one: Yes No

Are you willing to have a representative from HHR make an appointment to visit your home?*
Choose one: Yes No

Harter's Hospice Rescue retains ownership of this pet. Do you agree to never sell, trade or surrender the pet to any agency? *
Choose one: Yes No

Do you agree to keep a harness or collar and identification tags on the foster dog at all times?*
Choose one: Yes No

I agree to notify Harter's Hospice Rescue immediately if the dog is lost or stolen and to make every effort to locate the animal.*
Choose one: Yes No

I agree to allow a Harter's Hospice Rescue agent representative to periodically check on this dog to be assured of compliance with this contract.*
Choose one: Yes No

I agree to notify Harter's Hospice Rescue if any of my personal information changes such as physical address, phone number, email address, etc.*
Choose one: Yes No

I agree the dog will not be euthanized without authorization from a Harter's Hospice Rescue board member. Voicemail and email does not imply acceptance from Harter's Hospice Rescue. I further agree a Harter's Hospice Rescue board member may want to visit the dog and evaluate the situation for them, and agree to make the dog, my vet or facility available to said board member. *
Choose one: Yes No

I agree and understand Harter's Hospice Rescue may have no prior information of age, breed, health issues, training, registration or other. Any information shared by Harter's Hospice Rescue is of its own experience with the pet and Harter's Hospice Rescue makes no warranties of any kind concerning pet.*
Choose one: Yes No

Harter's Hospice Rescue agrees to assume financial responsibility for all medical bills, food costs, and provide crate, collar, leash and monthly heart worm prevention. Unless foster chooses to provide these things themselves, Harter's Hospice Rescue will decide all food to be provided foster dogs. If foster parent desires something else, foster parent will assume financial responsibility for it. All medical exams and treatments must be cleared with Harter's Hospice Rescue before being undertaken. Foster parents will not be reimbursed without a previous agreement from Harter's Hospice Rescue. If, for any reason, this foster is not satisfactory to the Foster Parent, or if the foster fails to comply with the terms of foster agreement at any time during the life of the dog, the dog must be returned to Harter's Hospice Rescue. The dog may not be given away, sold, surrendered to a shelter, pound, other rescue group or another individual. I understand foster is responsible for boarding costs for a period of time, to be agreed upon beforehand, while Harter's Hospice Rescue finds a new foster home for the dog, if necessary. I understand Harter's Hospice Rescue has made no guarantees whatsoever as to health, temperament, mental disposition or training of the dog. I understand that having a foster may require preparation such as putting up a fence to keep him/her safe and putting away things the he/she may want to chew. Foster agrees to keep the dog as an in-home companion and not as an outdoor yard dog. The dog will be kept in the house and will not be tethered outside. I agree to not chain the dog or keep in a yard or crate longer than is appropriate for th individual dog's age, breed and need for activity. I agree to comply with all city, state and federal laws relating to animals, including "leash laws". I agree, if dog has not been altered previous to foster period due to age or time constraints, I will report to an appointment set up by Harter's Hospice Rescue to have the dog altered, or make the dog available for a representative of Harter's Hospice Rescue to take the dog. I also agree to perform any after care for dog as detailed by the veterinarian, and immediately report any problems, as detailed by the veterinarian, or Harter's Hospice Rescue staff member, to Harter's Hospice Rescue immediately. I certify that all statements made by me on this foster agreement are true and correct. I agree that Harter's Hospice Rescue has the right to confiscate the foster dog in the event that statements made by me are found to be false, I am in violation of the contract, or at any time during our relationship based on their own discretion.

I certify that the information I have given is accurate and true. I understand that any misrepresentation of the above information may authorize HHR to deny application, refuse foster privilege and/or reclaim the fostered pet. Enter your name and date.*