Foster Application

Applicant name

Street address

City

Phone number

Your email

What type of animal are you applying to foster?

Why do you want to foster for Cornerstone Hospice Pet Peace of Mind Program?

Do you live in a house, apartment, condo, military housing, other? Please specify.

If you rent, live in a condo, etc. do you have permission from the landlord/association to have a pet?
n/ayesno

Is there a limit to the length of time that you are able to foster?
yesno

If yes, how long?

Do you have a fenced-in yard?
yesno

Are there children living at your residence?
yesno

If yes, how many, and what are their ages?

Does anyone in the home have allergies to animals?
yesno

Where will your foster animal be kept during the day?

Where will your foster animal be kept at night?

How many hours will the foster animal(s) be home alone during a typical day?

If you have any other pets, please list them here:

Are they spayed/neutered and up-to-date on vaccinations?
n/ayesno

Please list any size limitations for a foster animal:

Veterinary Reference

NOTE: Please notify your veterinarian’s office that a representative from Cornerstone Hospice Pet Peace of Mind Program will be calling for a reference and that you give your permission to release information to us regarding the care of your personal companion animals.

Name of Veterinarian/Office:

Vet phone number:

Animal(s) treated at this office:

Personal References

In addition to veterinary reference, all applicants must have a personal reference. Please supply
contact information for a person who has known you for at least one year, who does not live with
you, and can personally attest to how you care for your own companion animal(s) or have cared
for their companion animal(s).

If you have volunteered for or worked with a shelter, animal control or rescue please supply that
information as a reference.

Name of Reference

Name of contact

Relationship

Group/organization name

Email address of contact

Phone number of contact

Cornerstone Hospice Pet Peace of Mind Program reserves the right to refuse any prospective foster home applicants.

Acceptance

By giving your acceptance you attest that all information above is true and correct and that you give permission to Cornerstone Hospice Pet Peace of Mind Program to check your references which may require disclosure of information that you have provided in this application or that you have given via email or conversation to the people you have listed as references, including, but not limited to your landlord/condo association and veterinary office.

Acceptance