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Heartworm Foster to Adopt Application

  1. Housing

  2. Please list your landlord's name.

  3. Fencing*

    A fenced yard is recommended for dogs however it is not required.

  4. Do you understand that heartworm treatment dogs will need to be kept indoors with periods of limited activity?*

  5. Do you have the ability to accommodate these needs?*

  6. Agreement*

    I understand that if I am approved for fostering, I will be given a treatment schedule and instructions for my foster dog. I will also be required to sign a contract detailing my commitment to caring for a heartworm positive dog before I take my foster dog home.

  7. Acknowledgement*

    I have read this Application in its entirety, and I agree that all statements contained in this document are made by me, and are truthful. I make this statement under penalty of perjury under the laws of the state(s) of North Carolina.

  8. Thank you!

    We appreciate your interest in being part of our Heartworm Foster to Adopt Program.

  9. Leave This Blank:

  10. This field is not part of the form submission.