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2. 
4. First Name*
5. Last Name*
7. Age*
8. E-mail*
10. Physical Address
12. Street Address 1*
14. Street Address 2
16. City, State, Zip Code*
18. County*
20. Home Phone Number
21. Cell Phone Number
22. Work Phone Number
24. Residential Dwelling *
    (Apartment, Single-Family Home, etc.)
25. Do you:*

    1. Own
    2. Rent
    3. Live With Parents
    4. Other
26. If Renting, please indicate landlord information:
28. Describe the activity level in your home:

    1. Busy/Noisy
    2. Moderate Comings/Goings
    3. Quiet with Occasional Guests
29. Please list all people living in the household*
    (Include Name, Relationship, Gender, and Age)
31. Does anyone in your household have allergies to animals?

    1. Yes
    2. No
32. Are all members of your family agreeable to Fostering a Dog/Cat?

    1. Yes
    2. No
34. Please list any pets you currently own
35. Would you be willing to have a Hall County Animal Shelter Team Member call your Veterinarian for a reference check?

    1. Yes
    2. No

    (If yes, Please authorize the Veterinarian to speak with us)
39. Veterinarian Information
41. First Name
42. Last Name
44. Street Address 1
46. Street Address 2
48. City, State, Zip Code
50. County
52. Phone Number
56. Do you have a preference in the sex of the foster?*

    1. Male
    2. Female
    3. No Preferance
57. Are you willing to foster a dog/cat of any age?

    1. Yes
    2. No
58. What size dog/cat are you willing to foster?

    (Check all that apply)

    1. Small
    2. Medium
    3. Large
60. Please describe the type of dog/cat you are willing to foster. We always want to make sure we have the best fit for our foster homes*

    (Please include breed, coat length, personality traits, energy level, hypoallergenic)

62. Are you willing to take your foster to vet appointments at a convenient time for you?

    1. Yes
    2. No
63. If No, please explain.
65. Are you willing and able to medicate your foster, even if it is just a monthly heartworm preventative?

    1. Yes
    2. No
66. We cannot guarantee a dog/cat to be housebroken, are you equipped to train with love and patience?

    1. Yes
    2. No
68. Have you had any experience with with an emotionally or physically neglected or abused dog/cat?

    1. Yes
    2. No
69. If Yes, please explain.
71. Are you willing to use a crate for a dog if recommended?

    1. Yes
    2. No
72. Do you have a fenced yard?

    1. Yes
    2. No
    3. Partial
74. If fenced, please give details on height, material, # of gates, are gates locked or lockable?
76. How many hours in a day would the foster be left alone?*
77. What are your plans to exercise/enrich your foster? Please list any parks or trails nearby, how many walks a day, approximate length, activities such as agility. *
79. By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully. I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any HCAS animal fostered by me. I certify that the above information is correct, and I understand that the information will be verified. I understand that by submitting this form electronically, I agree to release and covenant to hold harmless HCAS and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the foster dog(s)/cat(s). I accept full responsibility for the dog(s)/cat(s) actions at all times, and release HCAS from any liabilities or damages that may be incurred because of fostering such dog(s)/cat(s). I agree to have HCAS complete reference call checks and conduct a home visit inspection to be able to approve my foster application. I agree that if I'm unable to foster the dog(s)/cat(s) anymore that I will return the dog(s)/cat(s) to HCAS and try to give HCAS a three day period to try and find another suitable foster for the dog(s)/cat(s).
81. Your Full Name*
82. Date*
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84. Submit

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