Foster Home Application Please review the BARC foster policy here.Date:* MM slash DD slash YYYY Applicant InformationName:* First Last Suffix Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone Numbers:HomeWorkCell Email:* Enter Email Confirm Email Type of residence: Apartment Condo House Do you own or rent? Own Rent How long? If you rent, Landlord's Name and Phone Number: First Last Phone Number:Current Animals in the Household:#Cats#Dogs Are all the animals spayed/neutered? Yes No Are they current on vaccinations? Yes No Are they on Heartworm prevention? Yes No If yes, which type of heartworm prevention? Current Vet (Name of Clinic): Current Vet (Phone Number):Number of adults in your household?Number of children?How old are they? Do you have a fenced yard? Yes No What type of fence & how high? Where will the animal be kept? Inside Only Outside Only Both How long will the animal be alone?Please enter a number from 0 to 24.Please list any experience that you have had in the past with owning or fostering animals.Does everyone in your house understand the pet is only temporary? Yes No List your fostering preferences:Dog/ CatMale/ Female Any age or size restriction? Signature*By signing this, I acknowledge that I have filled out all of the above information truthfully on this date.
