[av_codeblock wrapper_element=” wrapper_element_attributes=”] Foster Application If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Today's Date * Full Name - Applicant 1 * Full Name Applicant 2 Address * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code Phone * Email * Please provide 3 Personal References, relationship, and phone #s: * First name, last name, relationship, home phone, cell phone First name, last name, relationship, home phone, cell phone First name, last name, relationship, home phone, cell phone Do you have children? * Please describe your home and yard: * Is it fenced in? Tell us about your current and previous pets! Breed/Age/Size? Who is your vet? * Please provide name, address, and phone #. Are all your pets spayed and/or neutered? Yes No Are your pets current on annual vaccinations? Yes No How many hours per day are you home? * How did did you hear about Hearts of Hope? * Why do you want to foster dogs? How would you rate your dog experience? Dogs Are My Life I Know The Basics Never Had One What type of dog would be ideal for your household? * Are you aware that a foster dog may be in your home for an indefinite period of time? * Yes No Are you open to special needs dogs? * Yes No Are you aware that most foster dogs have unknown medical and behavior history? * Yes No Are you willing to travel to pick up a foster dog? * Yes No Are you willing to travel to potential adopters for home visits? * Yes No Are you willing to transport the dog to the vet? * Yes No Do you agree to the following conditions? * Hearts of Hope Dog Rescue may refuse to place a dog with Applicant if any of the information provided herein is found to be untrue, and may terminate Applicant's foster assignment if information provided herein is found to be untrue after dog is placed with Applicant. I authorize Hearts of Hope Dog Rescue and any credit bureau or other investigative agency employed by Hearts of Hope Dog Rescue to investigate any references herein listed or statements or other data obtained from me. YesNo I CERTIFY THAT ALL OF THE INFORMATION I HAVE PROVIDED IN RESPONSE TO THE QUESTIONS CONTAINED IN THIS APPLICATION IS TRUE. I FURTHER CERTIFY THAT I HAVE READ THE CONDITIONS CONTAINED AT THE BOTTOM OF THE APPLICATION, THAT I UNDERSTAND THEM, AND THAT I VOLUNTARILY SUBMIT THE APPLICATION TO HEARTS OF HOPE DOG RESCUE. * YesNo Confirm that you are not a bot * [/av_codeblock]
