ࡱ> CEB ,bjbj>> .2qTqT,::,$<.:<<<<$j `<<<<뎽-. 0<[<:* d:   GATEWAY 4 PAWS  HYPERLINK "http://www.gateway4paws.org" www.gateway4paws.org  HYPERLINK "mailto:gateway4paws@gmail.com" gateway4paws@gmail.com  HYPERLINK "http://www.facebook.com/gateway4paws" \t "_blank" www.facebook.com/gateway4paws FOSTER HOME APPLICATION PO Box 414 Maryville, IL 62062 Name___________________________________________________________________ Address_________________________________________________________________ City______________________ State____ Zip Code__________ County ____________ Email_____________________________________ Date of Birth __________________ Phone (Home)_________________________(Cell)______________________________ Occupation__________________________ Employer___________________________ Work Full time____________ Part time ______________ Do not work ____________ Name, age and relationship of all other individuals in the home_____________________ _______________________________________________________________________ _______________________________________________________________________ Home__________ Apartment_________ Condo_________ Mobile Home____________ Do you own or rent_________ Landlord name and phone # if you rent _______________________________________________________________________ Is your yard fully enclosed by a fence____ Type of fence _____________ Height ______ If you do not have a fence, how will you take the foster dog out? ___________________ Is anyone home during the day? ____ If so, who? _______________________________ If not, how many hours will the foster dog be left alone? __________________________ Where will the foster be kept when alone? _____________________________________ Where will the foster spend days? ____________________________________________ Where will the foster sleep? _________________________________________________ Do you have other animals in the home? ____ Type/Age/Breed/Gender of all pets in the home: __________________________________________________________________ ________________________________________________________________________ Are they spayed/neutered? __________________________________________________ Date of last DHPP and rabies vaccinations? ____________________________________ Do your current animals get Bordetella? _______________________________________ Are they currently on heartworm preventative? _________________________________ If so, what do you use? ____________________________________________________ Are they currently on Flea/tick preventative? ___________________________________ If so, what do you use? ____________________________________________________ Do your personal pets live Inside or Outside ____________________________________ If outside, what is the purpose? ______________________________________________ Do you use a tie out? ______________________________________________________ Please provide name, address and phone number of your current veterinarian ________________________________________________________________________________________________________________________________________________ If less than 5 years, please provide vet information prior to the one above ________________________________________________________________________________________________________________________________________________ Have you fostered before? __________________________________________________ If yes, with which organization ______________________________________________ From what dates? _________________________________________________________ Do you plan on continuing to foster for them? __________________________________ Why do you want to foster? ________________________________________________________________________________________________________________________________________________ Do you have experience with dog training? ____________________________________ Aside from fostering, are there other ways in which you would like to help our rescue? Transport? _______ Home visits? ________ Other? _____________________________ What type of fostering are you interested in? General____ Temporary/emergency____ Hospice/long term____ Isolation fostering____ What type of dog are you willing to foster? Male ____ Female ____ Puppy ____ Young____ Adult ____ Senior ____ Are there any breeds you would not want to foster? ________________________________________________________________________ How many dogs would you be willing to foster at a time? _________________________ References: Name______________________ Phone_____________ Relationship_______________ Name______________________ Phone_____________ Relationship_______________ ABOUT US Gateway 4 Paws is a registered non-profit 501c3 organization that rescues small/medium breed dogs. We are an all foster based rescue and do not have a facility/shelter. We are all volunteers and do not receive any reimbursement from Gateway 4 Paws. Gateway 4 Paws provides all required veterinary care as instructed by USDA to the foster animal which includes spay/neuter, vaccinations, microchip, and care for any illness. We do not provide any veterinary care to your personal animals. The foster provides the love, time, shelter, and supplies needed to care for their fosters. Gateway 4 Paws will do its very best to provide food. In some cases, you may need to purchase food. All purchases and mileage can be deducted on your taxes. ACKNOWLEDGEMENT I acknowledge that the information contained in this application is true and correct to the best of my knowledge. I also understand that Gateway 4 Paws is not responsible for any physical damage to my home, anyone in my home or my pets caused by the fostered animal(s). 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