Safe Harbor Farm 

   Name:

   Street Address:

   City:          Zip Code:

   Mailing address:

   Phone number:        Alternate phone number: 

   E-mail address: 

   Employer:      Spouse's employer: 

   Own or rent?:  own   rent

   If you rent, do you have your landlord's permission to house this pet?  yes   no

   Do you have a fenced-in yard?  yes   no

   Number of adults in the household: 

   Number of children and their ages: 

   Are you or your spouse pregnant or trying to be?:  yes   no

   Does anyone in the household smoke?  yes  no

   When you are at home, where will this foster-pet be kept? 

   When you are not at home, where will this foster-pet be kept? 

   When the family is sleeping, where will this foster-pet be kept? 

   What cats do you have presently? 

   What dogs do you have presently? 

   What other animals do you have presently? 

   Other pets or foster-pets housed in the past 6 years: 

   What happened to them? 

   Have any pets of yours ever had a litter?:  yes   no

   If so, please explain the circumstances: 

   When you travel, who takes care of your pets?  

   Do you own any crates?  yes   no

   SHF pet or type of pet that you would like to foster: 

   Energy level preferred:  high medium low no preference   

   Reason for fostering a pet: 

   Veterinarians seen in the past 6 years: 

   Vet of choice: 

   Ever take a course in dog obedience?  yes  no

   Ever read any books on dog or cat behavior?   yes  no

   Animals often come to SHF unneutered, unvaccinated and with medical and/or behavioral problems.  We will always neuter and vaccinate ASAP and disclose all known issues.  Please check off any problems you'd prefer not to handle:  upper respiratory problems (altho' mild, these can be contagious) dogs on heartworm treatment ear cleanings & treatments non-contagious skin problems heartworm preventative wound care grooming animals on daily medications

   Your annual budget for pet care is:     

   Your limit for emergency care of pets is:    (Please note: veterinary expenses not pre-approved by SHF's director will NOT be reimbursed.)

   Have you or any member of your household ever been brought up on animal abuse or domestic abuse charges?   yes  no

   Do you have any reason to suspect a member of your extended family has a history or tendency toward domestic violence (including animal abuse)?   yes  no

   If so, who and where do they live? 

   Have you read all of SHF's fostering policies?  yes  no

   Are you available for PetSmart adoptathon days (roughly once a month on a Sunday)?  yes     no 

   When will you be available to volunteer once or twice at SHF so we can get to know you? 

   Please list any questions you might have for us: 

   Please provide two character references from non-relatives, together with their contact phone number: