First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Cell Phone*

Alt Email

Occupation and Employer of the primary financial member of the household*

If you are UNDER the age of 21, what is your age?

Name of Person or Business that referred you to Save a Stray

Is this application for a dog Save a Stray is helping you with? If yes, please list dog's (or dogs) name.*

Have you ever fostered before? If yes, for which Rescue Group/Shelter*

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home*
Choose one: Rent Own

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What type of fence
Choose one: Privacy Chain Link Invisible

What is the height of the fence

List pets you currently own (name, breed, and age)*

Are your current pets spayed or neutered?*
Choose one: Yes No N/A

Are your current pets up to date on vaccinations?*
Choose one: Yes No N/A

Which brand of heartworm and flea prevention do you currently use or have used in the past?*

Are your current pets pet friendly

Current or Prior Veterinarian's Name and Phone Number (to be used as a reference, PLEASE contact them to allow information to be given to us)*

Name of the person the vet records are listed under?*

Additional Comments