PAWS Questionnaire For Foster Home

PAWS is dedicated to helping animals; this includes placing unwanted pets in caring, responsible homes. This questionnaire has been designed to help us determine whether a potential foster home meets our guidelines.

SECTION I
NAME*
ADDRESS (include city, state, zip)
PHONE (Home)*
PHONE (Cell)*
PHONE (Secondary)*
EMAIL*
Are you Employed    Student    Retired    Other   
Type of residence House (Own) 
House (Rent) 
Apartment/town home
Mobile home 
If you rent, does landlord allow pets? Yes    No   
Landlord's Name
Phone number
(will be verified by a PAWS representative)
Do you plan to move in the near future? Yes    No   
Are other family members aware you plan to foster a pet? Yes    No   
SECTION II
1. Reason for being a foster home   provider
2. Number of adults in home
    Number of children in home
    Ages of children
3. Do you have pets now? Yes    No   
    How many -
  Dogs               Cats               Other
 
4. If you have pets, how many are spayed/neutered?
    Current on vaccinations?
5. What kind of pets have you had in the past?
6. What happened to your last pet?
7. Have you ever lost a pet due to Poisoned
Hit by car 
Disease   
Strayed/stolen  
Old age 
Other 
8. Have you ever had to give up a pet? Yes    No   
  If yes, why?
 
9. Have you ever been refused by a humane organization for an adoption?
  Yes    No   
If yes, when?
 
What organization?
What was their reason?
10. PAWS will provide food and vet care for animals in your care. Are you willing to provide the animal with proper shelter, attention and care?
 
11. Is anyone in your family allergic to animals? Yes    No   
12. Who is your present vet?
     Phone number
13. What times would be good for a PAWS representative to call or visit?
 
SECTION III
1. Where will the animal live? Indoors    Outside    Combination of both 
  If outside, how will it be confined?
 
  If outside, what kind of shelter do you have?
 
  How do you plan to train/assist in house training, if necessary?
 
2. Do you feel willing and able to work with the animal to correct any problem behavior if it should develop (barking, escaping, digging, chewing, etc.)?
  Yes    No   
    What are your ideas for dealing with such behavior?
  (Not all problem behavior can be corrected, but most of it can with patience, perseverance and expert help if needed.)
3. Who will be responsible for the animal's care?
4. About how many hours a day will the animal be left alone?
       Days a week?
5. Where will it be kept when left alone?
6. Are you prepared to give the animal plenty of time (at least two weeks in most cases - possibly more if you have other pets) to adjust to its new home?
  Yes    No   
7. Would you consider fostering two animals for companionship - especially if there is often no one home?
  Yes    No   
I hereby release the City of Jefferson, Iowa, the County of Greene, Iowa, and the People for Animal Welfare Society (PAWS) of Greene County, Iowa from all liability to me and my successors for any and all damage or loss, and any claim or demand therefore, on account of any injury resulting from my performing the services described above. I also agree to indemnify and hold harmless the City of Jefferson, Iowa, the County of Greene, Iowa, and PAWS of Greene County, Iowa for any loss, liability, damage or cost they may incur as a result of my performing such services.
I certify that the information I have given is true and authorize investigation of all statements made above. I understand why PAWS has the right to refuse any request for adoption. I also give my permission to share information about me that may be obtained during interviews, reference checks, etc., with other humane organizations.
FOSTER HOME PROVIDER
DATE
NOTES/FURTHER COMMENTS

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