WISH BONE CANINE RESCUE FOSTER APPLICATION

Bloomington, Illinois

You must be at least 21 years old and live within 60 minutes of Bloomington/Normal, Illinois to foster dogs for Wish Bone Canine Rescue.

All dogs in your home must have up-to-date vaccinations and be spayed/neutered before completing this application. If you have a landlord, please talk with them about fostering prior to completing this application. Dogs in foster care may not be taken to your place of employment.

*Indicates required response

Today's Date * +

First name *

Last name *

Street Address *

Address 2nd line (if necessary)

City *

State (2 letter abbreviation) *

Zip code *

Email Address *

Telephone (daytime) *

Telephone (evening) *

Same as daytime

Different number

Evening Telephone *

Preferred method of contact *

Telephone daytime

Telephone evening

Email

Text

Have you ever been investigated for, charged with or convicted of animal negligence, abuse or cruelty? *

No

Yes

Please explain the details of this investigation. *

Do you own or rent your place of residence?

*

I own my place of residence

I rent my place of residence

Type of residence: *

Name of trailer court: *

Please provide your landlord's name. *

Please provide your landlord's phone number. *

How many hours a day will your foster dog spend alone? *

Will your foster dogs live inside your home?

*

Yes

No

Please describe where your foster dog will live. *

Do you have a fenced yard? *

No

Yes

Height of fence. *

Select which types of animals are in your family?
(Please check all that apply) *

Dog (s)

Cat (s)

None

Other Other

Please list your pets' names and describe them, including breed, sex and age. *

0/2000 words

Current Veterinarian's name

*

Current Veterinarian's phone number *

What person's name are your pets under at veterinarian? *

Please check all that apply for your DOGS. *

Spayed/Neutered

On flea/tick prevention

On veterinarian prescribed heartworm prevention

Up to date on rabies vaccination

Up to date on bordetalla vaccine (kennel cough)

Up to date on other vaccines recommended by vet

None of the above

Which Heartworm preventative are you using? *

Which flea/tick preventative are you using? *

Have you had dogs in your family within the past year? *

Yes

No

Describe dogs previously in your family? *

Veterinarian's name and phone number for previous pets.

*

Do you have any children living at home or visiting regularly? *

Yes

No

What are their ages? *

Do all persons living in your home agree with fostering dogs? *

Yes

No

Please explain who is not in favor of fostering. *

Are you interested in serving as an emergency foster or permanent foster? An emergency foster cares for a dog until a permanent foster can be found. This allows us to save an animal immediately. A permanent foster home cares for a dog until he is adopted. There is never any obligation to continue fostering a dog if it is not working out for you. You may elect to be both an emergency and a permanent foster. *

Emergency

Permanent

Are you applying to foster with the intent of adopting a dog? *

Yes

No

When would you like to begin fostering a dog? *

Do you have any fostering preferences?
Please use this space to identify specifications you have for fostering; for example, small dogs only, no golden retrievers, low shed, etc. *

0/255 characters

If there is a specific dog on our website that you are interested in fostering, please enter the dog's name here. *

Background Information
(Indicate if you been convicted of criminal misdemeanor or felony) *

Criminal misdemeanor last 7 years

Felony last 7 years

No criminal misdemeanor or felony last 7 yrs

Please explain the circumstances of your conviction. *

Personal Reference #1 *

Phone Number Reference #1 *

Personal Reference #2 *

Phone Number Reference #2 *

Please enter any additional comments.

May we add you to our email list for distribution of our newsletter and other newsflashes about Wish Bone Rescue? We do not share our email list with others. *

Yes

No

Terms of Fostering

By checking the box below you are

(1) certifying that all information in this application is accurate and that you have not withheld pertinent information.
(2) authorizing Wish Bone Canine Rescue to contact your personal veterinarian to verify information you have submitted in this application.
(3) certifying that you are 21 years of age or older.
(4)acknowledging you understand that Wish Bone Canine Rescue reserves the right to deny any application for any reason without stated cause.

After checking the box below, remember to click the submit button to finalize your application. Thanks again for your interest in adopting one of our rescued animals.

*

I have read and agree with the terms in the above referenced documents.

Single Family Home	Duplex/Triplex/Quad
Apartment	Condominium
Trailer Court	Other Other