Kennebec Valley Humane Society
Foster Family Application
Name: 
Name and ages of all persons living in Foster Home: 

Address: 

Telephone:    Home:      Work:

Do you own a home or rent?  Own or  Rent


If you rent, what is your landlords name and phone number?

 Name:
Phone:


Name, age and sex of each pet living in home: 
 
Are these pets spayed or neutered?
Yes or No
Other:
Are pets current on vaccinations?
Yes or No
Other:

Are there any special considerations as to the temperament or health of your animals that KVHS needs to consider before placing a foster pet in your home?		 Yes or No
If yes, what?

Do you have a separate room where the animal(s) can be isolated if required?		 Yes or No

Name of your veterinarian:

May we contact him/her for reference purposes?		 Yes or No


What kind of animal are you interested in fostering?
Injured Animals Cat    Dog
Pregnant/Nursing Animals Cat    Dog
Minor contagious medical condition Cat    Dog
Animal belonging to someone who is ill Cat    Dog
Other:   
   
Are you willing take a dog/puppy that may not be housebroken? Yes or No
   
What type of behavior modification do you normally practice with your pets?

Signature: 
Date: