Owner Intake Form

Owner Intake Form

Overview of situation

Owner agreement to place pet(s) in short term foster care As an owner of a pet to be fostered in an emergency situation for a short term, by the Safe Pets Safe Families program we need to make the best decision regarding animals being placed into care and ensure a positive experience for both you and the animals. Please complete this application and add any other information that may be of help us in finding a suitable foster carer: Your honesty will help find the right foster with less risk of needing to be moved.

Why are you seeking care for your animals?

Domestic Violence
Homelessness
mental illness needing respite hospital care
family breakdown
incarceration
medical illness

Referring agency and contact person *

Client Name *

First

Last

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email *

Emergency contact / Relationship to you *

Phone *

Pets name *

Photo 1

Click or drag a file to this area to upload.

please upload photos of your pets

Photo 2

Click or drag a file to this area to upload.

Can your pets photo be shared publicly *

Species and breed *

Sex and age *

Previous veterinarian *

is your pet desexed? *

if not are you willing to have your pet desexed

If no reason why

Is your pet vaccinated? If so which one? Dog C5, C3 Cat F3, F4 *

Date of last vaccination

Vaccination records

Click or drag a file to this area to upload.

If you have a cat coming in care is it FIV positive

Is your pet microchipped ? *

Microchip no.

Is microchip in your name? *

If you have a dog coming in care, is the dog registered? *

Is the dog registered in your name? *

If not, who's name is the dog registered in?

What council is the dog registered in? *

If you have a dog coming in care, is there a current dangerous dog order or has there been? *

If yes please explain

Is your pet toilet trained? *

What does your pet usually eat? *

What time does your pet eat *

What treats does your pet like? *

Has any food caused problems? *

If so please explain

Does your pet have food aggression *

if so please explain

Where does your pet usually sleep? *

Have you ever had your pet/s in care before? if so where? *

Can you give us any information that would helpful in fostering your animal? *

Does your animal have behavioural issues? Destructive? Dig holes? Barks or howls? escapes from the yard? If yes please describe

Does your animal normally live in a house, apartment, unit, rural or other

Is your animal accustomed to children in your household? *

If yes, what are their ages? *

Has your pet ever been aggressive towards children or people in general *

if yes please explain

How many hours a day are your pets accustomed to having company?

Does your pet relate well and friendly with other animals? What animals have they lived with before?

If you have a dog is the dog well behaved on a leash walking in public?

Does your dog travel well in the car?

Where do your pets stay when you are out the house?

How did you hear about the foster program?

I agree by signing this document. I hereby indemnify Safe Pets Safe Families Inc, its staff, volunteers and all agents against all actions, court proceedings, claims, demands for damages compensation, cost, or otherwise arising out of or in respect of Safe Pets Safe Families Inc providing emergency accommodation, including any vet care given. In consideration of Safe Pets Safe Families Inc providing such emergency accommodation, I agree that I will not make any claim or demand against Safe Pets Safe Families Inc or any of its staff, volunteers or agents, for anything arising out of or in connection with Safe Pets Safe families Inc providing such emergency accommodation for my animals. If I miss a charity contribution donation agreed upon or become uncontactable for a period of more than two weeks my animal(s) will become the sole property of Safe Pets Safe Families and I will have no further rights in respect of my animals(s) Safe Pets safe families Inc may then, at its discretion, take responsibility for the future care and assessment of suitability for adoption of my animal.

I hereby indemnify Safe Pets Safe Families Inc, its staff, volunteers and all agents against all actions, court proceedings, claims, demands for damages compensation, cost, or otherwise arising out of or in respect of Safe Pets Safe Families Inc providing emergency accommodation, including any vet care given. In consideration of Safe Pets Safe Families Inc providing such emergency accommodation, I agree that I will not make any claim or demand against Safe Pets Safe Families Inc or any of its staff, volunteers or agents, for anything arising out of or in connection with Safe Pets Safe families Inc providing such emergency accommodation for my animals. If I miss a charity contribution donation agreed upon or become uncontactable for a period of more than two weeks my animal(s) will become the sole property of Safe Pets Safe Families and I will have no further rights in respect of my animals(s) Safe Pets safe families Inc may then, at its discretion, take responsibility for the future care and assessment of suitability for adoption of my animal.

Date