Thank you for your interest in becoming a foster home for senior pets! Please allow 7 days to process your application. Thank you! Applicant Information Application Name* Date* Address 1* Address 2 City* State* AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip* Home Phone* Cell Phone Email Address* Best Time to Contact* Are you at least 25 years of age? Yes No Co-Applicant Name* Do you have a current tetanus vaccination? Yes No How did you hear about the Young at Heart foster home program?* I am applying to foster: Dogs Cats Either Dog or Cat Residence & Family Members Please select your residence type: House Townhouse Apartment Condo Other Do you own your residence? Own Rent Other Do you have a fenced-in yard? Yes No If yes, how high and of what type of construction? If you lease, does your lease have restrictions regarding animals? Yes No If yes, please explain: Landlord Name Landlord Phone Number Please list all people who live at your residence (include names, ages and relationship for each resident)* Is anyone home during the day? Yes No If yes, who is home? If no, how long will the foster animal be left alone each day? Do you or anyone in your home have any physical or medical conditions that should be considered when matching your family with an appropriate foster dog or cat? Yes No If yes, please describe: Please list all pets that live at your residence (for each pet, include the name, type, breed, age, gender and whether or not the pet is spayed/neutered)* Do any of your personal pets have issues that would make a foster animal unsuitable for your home? (i.e. dog that doesn’t like other dogs) Ye Yes No If yes, please explain Veterinarian for Current or Past Pets Please list your most recent veterinarian that we may contact for a reference:* Phone Number* Fostering Preferences/Experience How soon are you available to foster? Immediately 1 Week 2 Weeks 30 Days Other Maximum number of days you can foster at a time? 30 days 60 days 90 days As long as needed If applying to foster dogs, please share the experience that you have. Novice (Don’t have much experience but am willing to learn) Experienced (Have a good deal of experience with common issues) Expert (Have experience with many different breeds as well as medical and/or behavioral issues) If yes, what organization(s) have you fostered for (Name, Phone)?* Do you have experience with caring for elderly dogs? Yes No Do you have experience with grooming dogs? Yes No Do you have experience with obedience training? Yes No If applying to foster cats, please share the experience that you have. Novice (Don’t have much experience but am willing to learn) Experienced (Have a good deal of experience with common issues) Expert (Have experience with many different breeds as well as medical and/or behavioral issues) If yes, what organization(s) have you fostered for (Name, Phone)?* Do you have experience with caring for elderly cats? Yes No Do you have experience with treating Upper Respiratory Infections? Yes No Do you have any size, breed, or gender preference for the animals you are willing to foster? Yes No If yes, please explain Environment Where will the foster dog or cat be kept during the day? Have the run of the house Be crated Blocked off/gated in part of the house or in a single room Yard Garage Basement Area with access to dog door Other Where will the foster dog or cat be kept at night? Have the run of the house Be crated Blocked off/gated in part of the house or in a single room Yard Garage Basement Area with access to dog door Other General If your foster animal requires medical attention, do you have a vehicle and the capability to immediately take the animal to visit a Young at Heart approved veterinarian? Yes No Have you ever been convicted of any charges related to animal cruelty, neglect, or endangerment? A criminal background check is required for all foster parents. Yes No If yes, please explain The state of Illinois Department of Agriculture requires each foster home to submit a Foster Home License Application along with a $25 per year application fee. Do you agree to pay the initial $25 fee in order to foster? Yearly license renewal fees will be paid for by Young at Heart for active foster homes. Yes No To be a successful foster home it is important for every person in the household to approve of an animal being fostered in their home. Is everyone in the home comfortable with this? Yes No If no, please explain Young at Heart must conduct a home visit prior to approving any foster application. Is this okay with you and everyone in your household? Yes No If no, please explain What time of day would work best for a home visit? Weekday/Weekend AM/PM Do you know the limit of animals allowed per residence in your town? Yes No If yes, what is this number? References Please provide three references (two of which are not related to you) with phone number and email address for each reference.*
