First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone*

Alt Email

Date of Birth (You must be 25 years old or older to Adopt/Foster from Pixie Mamas Rescue)*

How did you hear about us?*

If you chose other, please explain.

Have you or are you currently volunteering/fostering with any other animal rescue groups? If yes, please list the name of that organization(s).*

Please list everyone that reseides in your home (Names & Ages).*

Does anyone in your home smoke?*

Does anyone in your home have allergies to animals?*

Do you own or rent your home?

Please provide your Landlord's contact information if applicable.

What type of home do you live in?*

Do you have a yard?

Please describe your yard (If you have 2 or more dogs currently and want to foster another, we require a fully fenced yard)
Choose all that apply: Unfenced yard Partially fenced Completely fenced yard

Height of Fence

What is the material of your fence?
Choose one: Chain Link Invisible Wood Wrought Iron Other

If other, please explain.

If you don’t have a fenced-in yard, do you agree to keep your foster dog on a leash at all times?
Choose one: Yes No

Veterinarian Office Name & Phone number: (You MUST call your vet's office and give permission to release information to PMR) Please list ALL veterinarians that your pets see*

Please contact your vet's office and give permission to release information to Pixie Mamas Rescue!

Please describe all pets currently with you (age, sex, BREEDS, WEIGHTS. Please note - If you have a current pet or pets, they must be up to date on vaccinations and SPAYED/NEUTERED. Cats must be current with rabies vaccine. Dogs must have annual vet exams.)*

Please describe pets that are no longer with you (within 10 years) and what happened to them

If you have ever given up a pet, please explain.

Do you have experience with
Choose all that apply: Small Dogs Medium Dogs Large Dogs

List any experience with specific breeds:

What experience do you have in caring for or training dogs? What training methods will you use?*

What types of dogs would you be interested in fostering?
Choose all that apply: Adult Dogs Puppies Mother & puppies Pregnant dog Long term hospice care Sick or injured dog/puppy Special needs Puppy Mill

How many hours during the AVERAGE day will this dog spend without a human?*

Where will this dog be when someone is home?*

Where will the dog be when home alone?*

Where will the dog sleep at night?*

Are you comfortable using a crate for your foster? We will provide a crate.

Do you have the ability to isolate or quarantine a pet if needed? (Such as a spare room dedicated solely to a foster pet) This is NOT a requirement, just informational.
Choose one: Yes No

By checking yes to this, you understand that fostering with PMR includes *Conducting Home Visits, *Attending Adoption Events, *Transportation to Vet Appointments, and other items that may arise. *
Choose one: Yes No

Please add any other information/comments you feel would be helpful

I certify that the information contained in this application is true and correct and I understand that before the placement of a rescue dog in my home, the information will be verified. I also agree to a personal interview to determine the suitability of my home and family to foster a dog for Pixie Mamas Rescue. I agree to allow a Pixie Mamas Rescue representative to visit my home.

By checking yes, you understand you will be expected to keep the animal safe and secure, return it to Pixie Mamas Rescue upon request, and not promise the animal to anyone or imply that you have the authority to approve a potential adoption. You agree to foster the dog at your own risk and indemnify and release Pixie Mamas Rescue, its officers, directors, and volunteers, of any liability arising from damages to person(s) or property caused by the dog. You understand that Pixie Mamas Rescue retains ownership of all animals placed in foster care until they are adopted.