Please fill out all fields marked with an asterisk (*) to complete the form.
Application will not be processed if it's incomplete.
Applicant Information:
First name *
Last name *
Age *
Street address *
City *
State *
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip code *
Phone number *
Cell Phone
Email address *
Please select your current type of housing: *
Please select one type of housing
House Condo/Apartment Mobile Home Student Housing
How long have you lived at your current residence? *
Do you rent or own? *
Please select one
Rent Own
Landlord’s name *
Landlord’s phone number *
Name of complex, if applicable
If applicable, else please enter N/A to submit the adoption application.
How many adults live in your home? *
Do children live in the home (or visit regularly?) *
No Yes
Please list the ages of each child *
Are all members of your household aware of your plans to foster? *
No Yes
Do you have any health conditions that which could restrict your ability to care for the animal? *
No Yes
If yes, please describe the health conditions. *
Have you ever been convicted of a crime? *
No Yes
If yes, please describe the convicted crime. *
Why do you want to foster an animal? *
Species interested in fostering: *
Cat Dog
Age range(s) interested in fostering: *
Neonatals Kittens/Puppies Young adults Adults Seniors
Types of animals I would like to foster:
Injured/sick animals Litters of kittens/puppies Pregnant animals Animals in behavior modification Animals that just need a break from a kennel Animals who need temporary placement until their owners can take them back
Please describe any other preferences or limitations on what animals you can foster:
Where will the foster animal spend most of its time? *
The foster animal needs to do well with:
Dogs Cats Young children
How many hours will the foster animal be alone? *
Who will be responsible for the animal? *
If necessary, how would you discipline the animal? *
Employment Information:
Please fill out for all of the adults in the household.
Employer *
Job Title *
How long at your present job? *
Additional Employer
Job Title
How long at the additional present job?
Please list your current veterinarian name & phone number, as well as any other vets you have had in the past 5 years.
Primary vet (where your current or previous pets most recent routine care would be):
Vet's Phone Number
Person’s name vet records are under (VERY IMPORTANT).
Additional Vets (please include same information as above)
Current & Past Animals Information:
Please provide information about any previous or current pets that you have owned in the last 5 years. For each pet, please include the following:
Pet's name:
Pet's species:
Pet's breed:
Pet's age:
Where the pet was vetted (if you have more than one vet):
Current Pets:
For previous pets, please also include the following:
If the pet is deceased, and if so when:
If not, why do you no longer have this pet and where they currently are?:
Previous Pets (any from the last 5 years)
Do you have cats? *
No Yes
Do you have dogs? *
No Yes
How will you confine animal to property?
References:
Please list 2 personal references.
Only 1 can be a relative.
Reference Name *
Reference Phone Number *
Amount of time known *
Reference Name *
Reference Phone Number *
Amount of time known *
I agree to the following:
*
To contact DHS before providing any medical care to the animal.
*
To return the animal to DeKalb Humane Society within 24 hours of request or if I can no longer care for the aniamal.
*
To respect DHS's adoption process and not rehome animals yourself.
*
That all information contained in this application is true. Should any information be found false, my application will be declined.
*
Should any information be found false after fostering, I will relinquish the animal immediately.
Signature (Please use your finger,stylus or mouse.)
Use finger, stylus or mouse.
Clear
Date *
Please list any additional information you feel is important for us to know.