First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

Text/Pager Email

Applicant Age*

Name and age of co-applicant, if any*

What type of home do you live in?*

Do you own this home?*

If not, please list the name and phone number for your current landlord

Please list the ages of all persons living at this residence.*

Tell us about you and your family. Why are you interested in fostering?*

Have you fostered before? *

Please list any pets you have had within the last 5 years: Type, age, and whether or not they were spayed/neutered. If they are no longer with you, please state reason why.*

Your current and/or past Vet's name and phone number. *

Personal Reference (name, email address or phone number, and relationship to you)*

What type of animal are you interested in fostering? *

How did you find out about Delaware Pet Rescue?*

DPR provides all medical expenses, food, and supplies. If your foster animal needs to see a vet, would you be comfortable taking them to their appointment? Our vets are in Hockessin, DE and Kennett Square PA.*

I hereby give permission to Delaware Pet Rescue to contact my veterinarian to obtain information about past and present pets. I also authorize the rescue to verify the above information. I do understand that DPR makes no representation, warranty, or guarantee as to the size, health or disposition of any animal because DPR is uncertain of its background. Please type your full name to reflect electronic signature.*

Anything else you would like to tell us, or any other comments you may have?