Owner Intake Form Owner Intake Form Owner Intake Form Owner intake formOwner 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 ViolenceHomelessnessphysical/mental illness needing hospital carefamily breakdownReferring agency and contact person *Name *FirstLastAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia (Republic of)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States of AmericaUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweCountryPhoneEmail *DOB *Emergency contact *Phone *Pets name *File Uploadplease upload photos of your petsCan your pets photo be shared publicly *yesNoSpecies and breed *Sex and age *Previous veterinarian *is your pet desexed? *if not are you willing to have your pet desexedYesNoIf no reason whyIs your pet vaccinated? If so which one? Dog C5, C3 Cat F3, F4 *Date of last vaccination Vaccination recordsIf you have a cat coming in care is it FIV positiveIs your pet microchipped ? *YesNo Microchip no.Is microchip in your name? *YesNoIf you have a dog coming in care, is the dog registered? *YesNoIs the dog registered in your name? *YesNoIf 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 explainIs your pet toilet trained? *YesNoWhat 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 explainDoes your pet have food aggression *if so please explainWhere 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? *YesNoIf yes, what are their ages? *Has your pet ever been aggressive towards children or people in general *if yes please explainHow 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?SignatureClear SignatureI 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 MessageSubmit Connect With Us On Insta Wow!!!! So exciting. Celebrating 1000 foster pets, The story of our Logo....The text being the same s Can't say this loud enough this is on our receptio Thank you to Annie from @pawsforchangeau for visi Buddy and his Dad also got a visit from Christmas More pictures of Andrea's and Ray's Christmas visi Share this:TwitterFacebookLike this:Like Loading...