Survey - Boston Foster Application

1.

Please complete the following:

*

Name:

First Required	Last Required

*

Email: Required

*

Street 1: Required

Street 2:

*

City/State/ZIP:

City Required	State Required	ZIP Required

*

Phone Number: Required

*

Date of Birth: Required

Date of Birth:

Yes, I would like to receive postal mail from The MSPCA-Angell

Keep me logged in. What's this?

2.

Question - Not Required - Please list a secondary phone if applicable

*3.

Question - Required - Preferred Method of Contact:

*4.

Question - Required - Please indicate which animals you are able to foster:
Please make between 1 and 9 selections from the choices below.

	Adult Cat with Upper Respiratory Infection
	Nursing Mom and litter of kittens
	Kittens in need of bottle feeding (requires you to feed every 2-3 hours throughout the day and night)
	Feral Kittens (require intensive socialization)
	Shy Cat Adoption Ambassador Foster
	Single Kitten or Pair of Kittens
	Litter of Kittens
	Rabbit
	Guinea pig
	Hamster
	Mice/Rats

*5.

Question - Required - Do you own or rent your home?

Own

Rent

*6.

Question - Required - What kind of home do you live in?

7.

Question - Not Required - Landlord's name (if applicable):

8.

Question - Not Required - Landlord's phone number: (if applicable)

*9.

Question - Required - Does your lease allow for pets?

*10.

Question - Required - Do you have your landlord's permission to foster

Please provide the following information about your household:

*11.

Question - Required - How many adults?

*12.

Question - Required - How many children?

*13.

Question - Required - Ages of children:

*14.

Question - Required - Do all members of the household wish to foster animals for the MSPCA?

*15.

Question - Required - Do any members of your household have allergies to animals?

Yes

No

16.

Question - Not Required - If yes, how do you cope with this?

(Maximum response 255 chars, approx. 5 rows of text)

*17.

Question - Required - How many hours a day are you away from home?

*18.

Question - Required - What are the animal care arrangements when you are not at home?

(Maximum response 255 chars, approx. 5 rows of text)

*19.

Question - Required - Do you have any pets now?

*20.

Question - Required - Please list any pets you have in your household and include name, type of animal, age,sex, and whether they are spayed or neutered.

21.

Question - Not Required - What is the name/town/phone number of your veterinarian?

(Maximum response 255 chars, approx. 5 rows of text)

Please Note. Foster Animals will be cared for and treated by the MSPCA's Veterinary Staff.

22.

Question - Not Required - Are your pets' immunizations current?

23.

Question - Not Required - Do your pets have any behavioral problems or a chronic illness? If so, explain:

*24.

Question - Required - Describe any prior/current experience you have with caring for animals.

(Maximum response 255 chars, approx. 5 rows of text)

*25.

Question - Required - Do you have a separate space to keep your foster animal (s)?

26.

Question - Not Required - If yes, please describe

27.

Question - Not Required - How will you segregate the foster animals from your own pets?

General Information:

*28.

Question - Required - Would you permit an MSPCA Foster Program staff member to visit your home?

*29.

Question - Required - Have you ever administered medication to a dog or a cat before?

30.

Question - Not Required - Do you have any special skills, training or interests?

(Maximum response 255 chars, approx. 5 rows of text)

*31.

Question - Required - Please list at least two references with contact information. Professional animal-related references (friends whose pets you have cared for, veterinarians, groomers, etc) are wonderful if you have them.

*32.

Question - Required - How did you hear about the foster care program

33.

Question - Not Required - If Other Please Describe:

By submitting this form, you are certifying that the information you have given on this application is true.