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Foster Parent Application
Type of animal:
*
Dogs
Cats
Both
Gender
*
Male
Female
No Prefrence
Age:
*
Check all that apply
Newborn (6 months and under)
Young (6 months - 1 year)
Adult (1 year - 6 years)
Senior (6+ years)
Good with:
*
Check all that apply
Dogs
Cats
Children
Activity level:
*
Check all that apply
Low
Average
High
Sometimes AAT takes in pets that require a little bit more care. What conditions/special needs/medical needs are you NOT comfortable handling?
*
EX: giving medications, behavioral training, etc
Do you give permission for an AAT representative to visit your home to do a home check?
*
Yes
No
Do all adults in the household consent to a background check being performed?
*
Yes
No
Personal Information
Applicant's name
*
Please provide name as it is listed on the driver's license.
First
Last
Driver's License
*
Number
Issuing State
Phone
*
Email
*
Do you have a spouse?
*
No
Yes
Spouse's Name
*
Please provide name as it is listed on the driver's license.
First
Last
Spouse's driver's license
*
Number
Issuing state
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
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
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Additional adults in the household:
*
0
1
2
3
4
1. Name
*
Please provide name as it is listed on the driver's license.
First
Last
Driver's license
*
Number
Issuing state
2. Name
*
Please provide name as it is listed on the driver's license.
First
Last
Driver's license
*
Number
Issuing state
3. Name
*
Please provide name as it is listed on the driver's license.
First
Last
Driver's license
*
Number
Issuing state
4. Name
*
Please provide name as it is listed on the driver's license.
First
Last
Driver's license
*
Number
Issuing state
Number of children in household:
*
0
1
2
3
4
5+
Children's ages:
*
Household Information
Does anyone in the household have pet allergies?
*
Yes
No
Does anyone in the household have asthma?
*
Yes
No
Do all the adults in the household consent to fostering?
*
Yes
No
I live in a:
*
House
Apartment/Condo
Townhome/Duplex
Manufactured/Mobile Home
My home is:
*
Rented
Owned
Name of apartment complex or landlord:
*
Phone number of apartment complex or landlord:
*
Does your complex or landlord agree to you fostering?
*
Is there a size, weight, and/or breed restriction?
*
Do you have a fenced yard?
*
Yes
No
Type of fence:
*
Wood
Chainlink
Other
N/A
Height of fence (feet):
*
How often does your family travel (3+ days away)?
*
Weekly
Monthly
A few times a year
Yearly
Every few years
Personal Pets
Do you currently have any other pets?
*
Yes
No
What kind?
*
Species; Breed; Gender; Age
Are all the pets in your household current on their shots?
*
Yes
No
Are all your dogs/cats spayed or neutered?
*
Yes
No
Are all your dogs on Heartworm preventive?
*
Yes
No
What brand and when was the last dose?
*
Veterinarian's name
*
Veterinarian's phone
*
Where did you hear about AAT?
I confirm that all the information in this application is correct and complete to the best of my knowledge.
Name
First
Last
Date
