Name

Address 

City      State     Zip 

Email

Phone (Home)     Cell/Work 

Type of Pet I am interested fostering  Cat Dog

(For Dogs)  Do you have a fenced yard?  Yes    No

(For Dogs)  How many other dogs are in your household? 

(For Cats)  How many cats are in your household?

    Indoor only 

    Outdoor only 

    Mixture of both 

(For Cats)  Do you have an area to quarantine your foster cats for an initial period after acceptance?  Yes    No

(For Cats)  Will they routinely be isolated from the other animals in your house?   Yes    No 

If you currently have other pets, please indicate kind and type               

Are these other pets spayed/neutered?    Yes No Some

Have you fostered with another organization?  Yes    No

    If yes, please specify who, when, where, and why you stopped.

Anything else you'd like to share with us.

I hereby state that this information provided on this application is true and correct to the best of my knowledge. I also realize that I will not be paid for my services as a volunteer and I release IMPACT for Animals of St.Louis from any liability whatsoever.

Name/Signature:      Date: