Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone*Home PhoneWork PhoneEmail* Your date of birth* How long have you lived at your current residence?*Do you:*OwnRentLive with parents/relative/friendIf renting, does your landlord/rental agency allow pets?YesNoI don't knowLandlord's name (verification required by landlord before approval) First Last Landlord's phoneName(s) and ages of other adult member(s) of householdIf you have children at home (or who visit frequently), what are their names and ages?Who will be responsible for this foster animal while it's in your care?*Who will have contact with the foster animal? List all people (visitors, babysitters, etc)*Please list all pets that live at your house, or will come into contact with this foster pet: Breed, age, sex, whether they are spay/neutered, time owned, personality with other dogs:*Have you ever had any disease in your home such as parvo? Feline leukemia or feline Aids?*YesNoI don't knowIf so, when and what?How long can you foster an animal?*Please check which animal(s) you are willing to foster.* Mothers with puppies Mothers with kittens Puppies Kittens Adult dogs Adult cats Any certain breed or size you prefer?*Can you give medications if needed? (pills or liquid)*YesNoAre you able to transport animals to vet appointments?*YesNoWhere will this animal be kept during the day?*Where will this animal be kept during the night?*Where will this animal be kept while you are away from home?*Do you have a fenced yard?*YesNoIf you have a fenced yard, how high is it (how many feet tall) and what is it made of (chain link, stockade, etc.)?If you do not have a fence how will you ensure that the animal will stay on your property and not run away?How much time during the day will the animal be left alone?*Please list 3 personal references.Personal Reference #1* First Last Personal Reference #1 Phone*Personal Reference #2* First Last Personal Reference #2 Phone*Personal Reference #3* First Last Personal Reference #3 Phone*The MDAR is not responsible for any accidents/incidents with animal while in your foster care.Your Signature (type your name)*I attest, by signing, that the above information is accurate and true to the best of my knowledge.Today's Date* Please note that we will respond to this application within 48-72 hours Mon-Fri. After you hit the "submit" button, you should receive confirmation of your submission. If you do not receive confirmation or a response from us, we likely did not receive your application. Please email us at firstname.lastname@example.org if you do not receive a response. If you have questions, please call 701-577-PETS (7387). MDAR reserves the right to refuse any applicant! Thank you!