Pet Owner Full Name

Branch of Service

Select One... Army Navy Marines Air Force National Guard Reserves

Current Address

City

State

Zip Code

Day Phone (include area code)

Evening Phone (include area code)

E-mail

Anticipated Foster Term

Select One... Up to 3 Months 3 Months to 5 Months 6 Months to 8 Months 9 Months to 11 Months 12 Months to 17 Months 18 Months to 24 Months

Foster Home Needed No Later Than

Would you like regular contact with us and your assigned Foster Home Care Provider?

Select One... Yes No

How did you learn about our organization and Foster Home program?

Select One... Flyer / Brochure Friend Military Contact Newspaper Internet Television Radio Social Media

Confirm you understand pet(s) are required to be spayed/neutered prior to acceptance by entering your initials.

Pet Related Expenses you can cover?

Individual who has been designated with authority to act on your behalf during deployment. Contacting this individual would only be needed if we are unable to reach you via email where we may need to transfer the pet to another foster home Care Provider.

Stateside POC Full Name

Relationship to Pet Owner

Current Address

City

State

Zip Code

Day Phone (include area code)

Evening Phone (include area code)

E-mail

Veterinarian Full Name

Veterinarian Business Name

Current Address

City

State

Zip Code

Day Phone (include area code)

Emergency Phone (include area code)

Veterinarian E-mail

Veterinarian Website

Pet Name

Type of Animal

Select One... Dog Cat Bird Horse Snake

Pet Breed

Pet Gender

Select One... Male Female

Pet Age

Pet Approximate Weight

Select One... Less than 10 Lbs. Less than 20 Lbs. Less than 30 Lbs. Less than 40 Lbs. Less than 50 Lbs. Less than 60 Lbs. More than 60 Lbs.

Pet is Spayed or Neutered

Select One... Yes No

Pet Color or Markings

Is Your Pet Microchipped?

Select One... Yes No

Current on Shots?

Select One... Yes No

Any Known Allergies?

Select One... Yes No Specify:

Heartworm Preventative?

Select One... Yes No Specify:

Current living environment:

Select One... Inside Outside Inside & Outside

Good with Other Animals

Select One... Yes No

If 'No' which type?

Is your pet good with young children?

Select One... Yes No

If 'No', provide the age group your pet should avoid:

Housetrained?

Select One... Yes No

Crate Trained?

Select One... Yes No

Under what circumstances may the dog exhibit aggressive, passive, or fearful behavior?

List any favorite games or toys your pet prefers:

Where does your pet sleep?

Type of Bedding?

Has your pet bitten or scratched anyone within last 10 days?

Select One... Yes No

Does your pet jump fences?

Select One... Yes No

Is your pet leashed trained?

Select One... Yes No

Has your pet had any obedience training?

Select One... Yes No

Does your pet know any tricks or commands?

Select One... Yes No

Type of Food (Brand Name, Formula, Canned or Kibble)

Describe amount of food fed and at what time:

Type of Treats:

Any Food Sensitivities?

Exercise and walking schedule:

Does your dog need regular grooming?

Select One... Yes No

Does your Dog have any Special Health Needs?
(Select all that apply)

None
Blindness
Chronic Ear Problem
Chronic Skin Problem
Deafness
Diabeates
Epilepsy

Describe 'Special Health Needs' that we should be aware of :

'Special Health Needs', Medications Required:

'Special Health Needs', Monthly Estimated Cost of Medications:

How often does pet need to go to veterinarian?

Other pertinent information about your pet or additional information pertaining to the information requested above, please provide below, so that we may best match your pet with a caring, loving, and safe environment during your deployment.

Any personal information provided to our organization is not shared outside of our network and is considered as confidential information and only shared with those within the organization that has a need to know.

We follow Operations Security guidelines in regards to confidentiality and sharing of information. Your name and telephone number is only shared with a potential foster home Care Provider after you have given us your permission to do so.

Authorization

By entering my full name below it indicates that I have provided full details about my pet and understand that an approved Foster Military Pets Volunteer Organization will assist me in the "Matching" of a temporary Foster home for my pet to the best of their ability.

I also understand that by submitting this application for foster care it does not guarantee that my pet will be matched with a foster care provider.

I also understand a response to my submission should be made within 48 hours and no later than three business days from date of submission.

Submitter's Full Name

Date Submitted

Sat Feb 04, 2012 21:10 pm

Select the Region you currently reside:

North Florida / SE Georgia Central Florida South Florida