Foster Application Michigan Anti-Cruelty Society Foster ApplicationDate* MM slash DD slash YYYY Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Cell #*Home #How many pets have you owned in the last 5 years?*DogsCatsHow many pets do you own at the present time?DogsCatsOtherPlease 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: Indoors Outdoors Veterinarian's name Veterinarian'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? Yes No If so, where? Do you:* Rent an apartment Rent a house Own a house Live with parents If 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?* Yes No If 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* MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.
