Foster Application Michigan Anti-Cruelty Society Foster ApplicationDate* Date Format: MM slash DD slash YYYY Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe 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: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* Date Format: MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
