Foster Application Michigan Anti-Cruelty Society Foster ApplicationDate* Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Cell #*Home #How many pets have you owned in the last 5 years?*DogsCats How many pets do you own at the present time?DogsCatsOther Please list pets individually below:Dog / CatSexSterilizedBreedName DogCatMaleFemaleYesNo Have you had a dog die on your premises of Distemper, Parvo, or unknown causes within the last 3 months?*Have you had a cat die on your premises of Distemper, Leukemia, or unknown causes within the last 3 months?*Do your pets live:IndoorsOutdoorsVeterinarian's nameVeterinarian's phoneHave you ever cared for: Young puppies Young kittens Injured dog Injured cat Do you have an area in your house to confine foster animals?YesNoIf so, where?Do you:*Rent an apartmentRent a houseOwn a houseLive with parentsIf you rent, what is your landlord's name?Lanlord's phoneWho will be the primary caretaker of the foster animal?*What hours will the caretaker be home?**Any children in the home?What agesIs your yard fenced? YesNoYesNoIf fostering a dog, what method will be used for house breaking?If fostering a dog, how would you handle chewing or destructive behavior?If fostering a cat, how will scratching or destructive behavior be handled?Have you ever fostered an animal for another shelter, organization, or group?*YesNoIf so, which one(s)?Are there any factors that may limit your foster work?*Why would you like to become a foster parent?*Tell us a little about yourself.Please indicate below what you would be willing to foster:* Sick / Injured cat Young kittens Mother cat and kittens Adult cat Sick / Injured dog Young puppies Mother dog and puppies Adult dog Additional comments:Thank you for taking the time to fill out this questionnaire. Although these questions may seem to be intrusive, they are essential in determining the successful placement of a foster animal into your home. Electronic Signature* First Last Date* EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.