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2. What type of animals are you interested in fostering? (Check all that apply)*

   1. Adult Dogs
   2. Puppies
   3. Nursing Dogs with Puppies
   4. Adult Cats

   1. Kittens
   2. Nursing Cats with Kittens
   3. Bottle-feeding puppies/kittens (willing to feed every 2-4 hours)
4. First Name*
5. Last Name*
7. Name(s) of Spouse/Partner/Roomate
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
16. Alternate Phone Number
18. Email Address
20. Expected Duration of Your Availability*
21. Availability to Come to the Shelter*
23. # of Children in the home*
24. Please list their ages
26. Do you frequently have children visiting the home*
    -- Select One --YesNo
28. Do you have any pets in your household?*
    -- Select One --YesNo
29. Type of Pets
    -- Select One --DogsCatsSmall Animals
31. Please list their species, breed, gender (spayed or neutered)
33. Are there limitations on what types of animal(s) your pet can be around (ie. male dogs, small animals, etc.)
35. Are your pets current on any vaccines? If yes, please select them below.

    1. Bordetella Vaccine
    2. Distemper/Parvo Vaccine

    1. Rabies Vaccine
    2. Heartworm Preventative

    1. Flea Preventative
37. # of hours a day will the foster be alone*
    -- Select One --less than 2 hours3-5 hours5-7 hours8+ hours
39. How will you keep the fostered animal(s) separate from your pets
41. Reference Name*
42. Phone Number*
44. Years Known*
45. Reference Type**
    -- Select One --PersonalProfessionalVeterinary
47. Reference Name*
48. Phone Number*
50. Years Known*
51. Reference Type*
    -- Select One --PersonalProfessionalVeterinary
53. Please list any special training or experince in animal care or handling you've received.
55. How did you hear about our Foster Program?
57. Electronic Signature Agreement*

    I certify that all the provided information is true. I acknowledge that Onslow County Animal Services will perform reference checks based upon this information. By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
59. Electronic Signature*
61. Agreement*

    I certify that I am over 18 years of age and that the information I have provided in this agreement is true and correct. I understand that falsification and/or noncompliance to any part of this agreement will result in termination of the agreement. We want fostering to be a positive and reward experience for you, your family, and any other pets you have. If at any time, you have questions or concerns, please contact the Foster Coordinator or OCAS immediately.

    1. I agree.
63. Electronic Signature*
64. Date*
Leave This Blank:


66. 1. Receive an email copy of this form.
67. Email address

    This field is not part of the form submission.

68. Submit Submit and Print

* indicates a required field