Foster Application Fields marked with an * are required General Information General Information First Name * Last Name * Address * City * State * - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware 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 Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Zip * Email * Phone * Best Time to Call * Morning Afternoon Evening Occupation * Employer Are You a Veteran? * Select No Yes I certify that I am at least 21 years old. * Divider What Brought You To PA Caring Hearts? What Brought You To PA Caring Hearts? How Did You Hear About PA Caring Hearts? * Google Search Attended an Event Saw PA Caring Hearts Signage Referral Social Media Press (TV/Radio/Publication) Other Check all that apply. If Other, Please State: If Referred, What relationship does this person have to PA Caring Hearts? Volunteer Adopter Foster Parent Staff Member Fan Check all that Apply. If Social Media, Which Platform? Select Facebook Twitter Instagram Divider I am applying to provide: * Short Term Foster Care Long Term Foster Care Hospice Care Your New Animal Companion Your New Animal Companion Which Caring Hearts dog/cat(s) are you interested in? * If undecided, type "any" and we will help match you with a perfect companion. I prefer a: * Dog Cat Either Have you ever had a dog before? * Select Yes No Have you ever had a cat before? * Select Yes No I prefer a: * Male Female Either Dog/Cat Size Preference: * Small Medium Large Any Which breeds have you been considering? * Where will your dog/cat stay during the day? What about at night? * What activities do you plan to participate in with this dog/cat? * If you are seeking a dog, how will you discipline your dog? Are any members of your family allergic to dogs? * Select Yes No Are any members of your family allergic to cats? * Select Yes No Divider Living Situation Living Situation How many adults (18 or older) live in your home? * Include yourself when counting. For each adult occupant of your home, please supply their age and their relationship to you. Are there any children (under 18) living in your home? * Yes No If Yes, what are their ages? Do you rent or own your home? * Rent Own If you rent, do you have permission from your landlord to own this pet? Select Yes No Do you have stairs inside or leading into your home? * Select Yes No If Yes, how many? We use this information to determine if your home would be suitable to our senior pets. Would you allow a Caring Hearts representative to visit your home? * Yes No Divider Current Animals Living in Your Home Current Animals Living in Your Home Do you currently have other pets? * Select Yes No If no, proceed to the next section. How many cats currently live in your home? * How many dogs currently live in your home? * Please provide the age and breed of each dog currently living in your home. Please describe any other pets you currently own. Have you ever given up a dog or cat? * Yes No If Yes, please explain the circumstances. Divider Additional Comments Additional Comments Is there anything else you would like us to know about you or the kind of dog/cat you want to foster? Certification Certification I certify that, to the best of my knowledge, the information provided in this questionnaire is true and complete. I recognize that any misrepresentation of that information will result in my losing the privilege of fostering a rescued animal from PA Caring Hearts. I understand that PA Caring Hearts has the right to deny my request to foster a dog/cat, and I authorize checking all information provided in this questionnaire. * If you are a human seeing this field, please leave it empty.