Date *

Today's Date

MM

DD

YYYY

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone *

(###)

###

####

Secondary Phone

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Phone *

(###)

###

####

If yes, what types of special needs would you be willing to help with?:

Check all that apply

Seniors Non‐contagious medical (i.e. deaf dogs, 3 legs, daily meds, etc.)

Contagious medical (i.e. ringworm, mange, FeLV, etc.)

Behavioral Issues

Underage puppies/kittens Bottle Babies

Can you provide the following for your foster: *

Check all that apply

Transportation

Vet Care

Training

Daily Excercise

I agree that a representative of Great Tails Animal Rescue may contact my veterinarian to confirm information provided herein regarding my pets and I consent to the release of such veterinary information by my veterinarian to Great Tails Animal Rescue. *

No

Yes

Do you have a fenced yard?

No

Yes

When you are home, the dog will primarily be:

Mark all that apply

Inside

Outside

When you are not home, the dog will be:

Mark all that apply

Inside

Outside

Crate

Would you be willing to foster unweaned puppies?

No

Yes

Where will the cat be kept?

Mark all that apply

Inside

Outside

Would you like to foster unweaned kittens?

No

Yes

Where will the small animal be kept?

Mark all that apply

Inside

Outside

Would you like to foster unweaned small animals?

No

Yes