foster application 1PERSONAL INFO2HOUSEHOLD INFO3PET CARE4REFERENCES Personal InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone*Secondary PhoneEmail* Marital Status*SingleMarriedDivorcedWidowedPrefer not to sayEducation Level*Did not graduate high schoolHigh school graduateSome college2 year degree4 year degreePost graduate workPost graduate diploma Household InformationDo you have family members or roommates living with you?* YES NO Number of Adults*Number of Children*Ages of Children* Do all of the adults work outside the home?* YES NO Type of Dwelling*HouseTownhouseApartmentCondoMobile HomeDo you have a completely fenced in yard?* YES NO Do you own or rent?* OWN RENT Rental InformationLandlord's Name* First Last Landlord's Phone*Rental Length*Less than 6 months6-11 months1-2 years3-4 years5-10 years10 years+Prior Landlord's Name First Last Prior Landlord's PhoneFoster EnvironmentPlease tell us about your home environment and your neighborhood (i.e. rural, lots of children, senior-citizen neighborhood, dog oriented neighborhood)*Why are you interested in fostering an animal for RPSM?*Please tell us about your experience caring for animals*Would you be willing to care for a rescue animal that has substantial medical issues that require a heavy level of attention?* YES NO Would you be willing to care for a rescue animal that has behavioral / socialization issues which may require extra attention?* YES NO How many RPSM dogs are you able to accommodate in your home for fostering?*12345Is there a particular type dog that you are interested in fostering? Also are there any types or breeds that you are unwilling to foster? PET CAREDo any animals currently reside in your home?* YES NO PET 1Name TypeDogCatAge SexMaleFemaleBreed Spayed/neutered? YES NO PET 2Name TypeDogCatAge SexMaleFemaleBreed Spayed/neutered? YES NO PET 3Name TypeDogCatAge SexMaleFemaleBreed Spayed/neutered? YES NO PET 4Name TypeDogCatAge SexMaleFemaleBreed Spayed/neutered? YES NO Current Vet's InformationName of practice PhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Personal ReferencesReference #1Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Relationship to this person* Reference #2Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Relationship to this person* How did you hear about RPSM?Personal ReferenceFacebookTwitterInternet searchPetFinderAdopt-A-PetAdoption eventFundraising eventOtherOther Please upload 3 photos of your fence, if you do not have a fence show us the area the dog will be pottied in.* Drop files here or Select files Max. file size: 64 MB. Due to Covid we will need to conduct your home visit via photos. We need to see these photos in order to help you prepare for fostering an RPSM foster dog. Please upload 2 photos of the common area where the dog will be living. We do not need to see bedrooms or bathrooms.*Max. file size: 64 MB.Due to Covid we need to do your home visit via photos. Foster ReleaseAs a member of RPSM, I pledge the following: 1. To abide by the by-laws and operating procedures of RPSM. 2. To conduct any activities related to RPSM in a volunteer capacity, receiving no compensation or substantial personal gift for it. 3. To educate potential adopters, the general public and current pet owners about issues regarding spay and neuter, I.D., temperament, health, training, care, etc. 4. To complete any RPSM volunteer activities as promptly as possible and to promptly notify RPSM leadership if unable to complete a volunteer activity. 5. To conduct myself in a courteous manner in all facets of RPSM work such that my behavior brings credit to the image of RPSM and animal rescue in general. 6. To support the spay/neuter policies of RPSM and attempt to educate the public as to the importance of spaying and neutering. I have read and fully understand the above Code of Ethics and the Bylaws of Refurbished Pets of Southern Michigan. I understand that a breach of these may result in my removal as a volunteer in good standing.* I agree*As a member of RPSM, I pledge the following: 1. To abide by the by-laws and operating procedures of RPSM. 2. To conduct any activities related to RPSM in a volunteer capacity, receiving no compensation or substantial personal gift for it. 3. To educate potential adopters, the general public and current pet owners about issues regarding spay and neuter, I.D., temperament, health, training, care, etc. 4. To complete any RPSM volunteer activities as promptly as possible and to promptly notify RPSM leadership if unable to complete a volunteer activity. 5. To conduct myself in a courteous manner in all facets of RPSM work such that my behavior brings credit to the image of RPSM and animal rescue in general. 6. To support the spay/neuter policies of RPSM and attempt to educate the public as to the importance of spaying and neutering. I have read and fully understand the above Code of Ethics and the Bylaws of Refurbished Pets of Southern Michigan. I understand that a breach of these may result in my removal as a volunteer in good standing. Name*If you would like to be considered as a possible foster family for one of our rescued pets, please sign and date below: I HERE BY ACCEPT RESPONSIBILITY FOR ANY/ALL ILLNESS THAT CAN OCCUR FROM A TEMPORARY CARE ANIMAL. I RELEASE REFURBISHED PETS OF SOUTHERN MICHIGAN FROM ANY AND ALL LIABILITY, NOW AND IN THE FUTURE, FROM MY VOLUNTARY ACTION OF CARING FOR ANY REFURBISHED PETS OF SOUTHERN MICHIGAN ANIMAL. Typing your name will be considered a legal digital signature. First Last To ensure your application will be received, please wait for the "Thank You for submitting…" message.CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
