Owner Intake Form

Owner intake form

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, maximum of 12 weeks 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
physical/mental illness needing hospital care
family breakdown

Referring agency and contact person *

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email *

File Upload

please upload photos of your pets

Can your pets photo be shared publicly *

yes
No

DOB *

Emergency contact *

Phone *

Pets name *

Species and breed *

Sex and age *

Previous veterinarian *

is your pet desexed? *

if not are you willing to have your pet desexed

Yes
No

If no reason why

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

Date of last vaccination

Vaccination records

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

Is your pet microchipped ? *

Yes
No

Microchip no.

Is microchip in your name? *

Yes
No

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

Yes
No

Is the dog registered in your name? *

Yes
No

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? *

Yes
No

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? *

Yes
No

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?

Signature

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

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