Holly's Place Foster Application

The following information is requested so that we can make the best placements possible for both the companion animal and you. Please answer all questions that are applicable to your situation.

In order to be considered as an adopter you must:

Date: Email Address:

Name of Applicant: Phone:

Street Address: City, State & Zip:

Will this be your first companion animal? Yes No

What kinds of companion animals have you had?

Which do you still have?

Have they been spayed or neutered? Yes No

If no, explain

What happened to the animals you no longer have?

Will your present animals adjust to a new one in the house? Yes No N/A

How many adults are there in your household?

How many children? Ages?

Does any household member have an allergy to dogs or cats? Yes No

How many hours will the animal be alone during the day?

Where will he/she be kept while alone?

Do you live in: House Apartment Mobile Home Other

Do you: Own Rent your home?

If you rent, may we contact the landlord to obtain permission for this cat or dogto live in your home? Yes No N/A

Landlord’s name and phone number:

Where do your current (or did your past) companion animals live? Indoor only Outdoor Only Indoor/Outdoor

Where will the new cat or dog live? Indoor only Outdoor Only Indoor/Outdoor

What are your feelings about cats and dogs getting on furniture?

What methods would you use to alter undesirable behavior in this cat or dog (such as scratching furniture, rough play, getting on counter tops, chewing, etc.)?

Have any of your past or current cats been declawed? Yes No
Your veterinarian’s name, address & phone number:

Do you have a completely fenced yard? Yes No

Fence height: What kind of fence?

If you drive a pickup truck, would you allow the dog to ride in the back? Yes No N/A

If you go away for a few days, or on a vacation, who will take care of the dog or cat?

Are you willing to have a representative of Holly's Place come to see where your dog or cat will be living? Yes No

Are you comfortable having potential adopters visit the dog or cat in your home?
Yes No

Would you be able to use a participating Holly's Place vet? (Clint Bevins of Animal Medical Center in Frankfort; Drs. Goodpaster, Jacoby, or Pike, of The Animal Clinic in Lawrenceburg, Dr. Hickey in Louisville) Yes No

Please list a non-family personal reference (with phone number):

Maximum length of foster care: 3 month 6 months 12 months

The information provided above is true and correct:

Signature Date