Heartworm Foster to Adopt Application

2. Name of dog you are interested in fostering*
4. First Name*
5. Last Name*
7. Email Address*
8. Daytime Phone*
9. Alternate Phone
11. Address1*
13. Address2
15. City*
16. State*
17. Zip*
19. Describe Yourself - your interests, your job, your favorite activities, etc.:*
21. Please list the names and ages of anyone in your extended family or friends with whom a fostered animal will frequently come in contact. Include name, relationship, age, gender, and frequency of contact:*
23. Do you currently own another pet or pets? If so, how are they doing? (List type of animals, breed, names, ages and sex, spayed/neutered or not? and a brief description of their personality.)*
25. Veterinarian to contact for vaccine history*
27. Housing

    1. I own my home.
    2. I rent my home.
28. Landlord
    Please list your landlord's name.
29. Landlord's daytime phone number
31. Fencing*

    1. My yard is fenced.
    2. I don't have a fenced yard.

    A fenced yard is recommended for dogs however it is not required.
33. Do you understand that heartworm treatment dogs will need to be kept indoors with periods of limited activity?*

    1. Yes
    2. No
34. Do you have the ability to accommodate these needs?*

    1. Yes
    2. No
36. This pet will need to visit the shelter on a weekday once a month for treatment. Please describe your typical schedule and if you would be able to commit to bringing this dog for appointments.*
38. Have you ever been charged with animal cruelty/neglect? *

    1. Yes
    2. No
40. Have you ever surrendered an animal to Iredell County Animal Services or any other animal shelter? *

    1. Yes
    2. No
42. Please explain why.
44. 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. I also understand that once the duration of fostering during treatment is complete, that I will then become the adopter of the foster dog, accepting all responsibilities for both daily basic living needs and all veterinary care.
    
    

    1. I understand
46. 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 with the understanding that any false or misleading information I give may result in the declination of my foster application for this dog and any future fosters or adoptions through Iredell County Animal Services.
    
    

    1. I agree
48. Thank you!
    We appreciate your interest in being part of our Heartworm Foster to Adopt Program.
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50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field