Foster Home Application

Foster homes are the backbone of every rescue organization, therefore, approving foster homes is also where a reputable organization needs to be especially diligent. So we ask you to please answer the following questions to help us with our assessment.

Note: If you would rather submit your application via mail, please click here for a printable version.

Fields marked with * are required.

Personal Information
Applicant Name*
First Last
Applicant's Driver's License #*
Do you have a Co-Applicant?*
- Yes
- No
Co-Applicant Name
First Last
Co-Applicant's Driver's License #
Address*
Street Address Address Line 2 City State / Province ZIP / Postal Code
Phone*
Additional Phone
Email*
Co-Applicant Email
How did you hear about us?
Employment Information
Employer*
Occupation*
Years at this job*
Employer's Address*
Street Address City State / Province ZIP / Postal Code
Employer's Phone*
Co-Applicant's Employer
Co-Applicant's Occupation
Co-Applicant's years at this job
Co-Applicant's Employer Address
Street Address Address Line 2 City State / Province ZIP / Postal Code
Co-Applicant's Employer Phone
References
Personal Reference #1*
Name Phone Email Relation Years
Personal Reference #2*
Name Phone Email Relation Years
Personal Reference #3*
Name Phone Email Relation Years
Veterinarians
Veterinary Clinic*
Dr. Name*
Address*
Street Address Address Line 2 City State / Province ZIP / Postal Code
Phone*
Email
Emergency Clinic
Dr. Name
Address
Street Address Address Line 2 City State / Province ZIP / Postal Code
Phone
Email
About Your Home
What type of home do you live in?*
- Condo
- Mobile Home
- Single Family Home
- Apartment
How long have you lived at your present address?*
Do you plan on moving in the near future?*
- Yes
- No
If yes, when and where?*
Do you own or rent your home?*
- Own
- Rent
Landlord Name
Renter - Rental Company
Renter - Landlord Phone
If you rent, written permission is required from your landlord. You may attach a document to this form or mail it to the address below to complete your application.

Midwest Akita Rescue Society
Attn: Foster Home Coordinator
6538 N. Nordica Ave.
Chicago, IL 60631
Written Permission from Landlord
Accepted file types: jpg, jpeg, png, gif, doc, docx, pdf, odt, Max. file size: 512 MB.
Is your yard fenced?*
- Yes
- No
If yes, how high is your fence and what kind of fencing material is used?*
If no, what type of leash walking regimen will you implement for the foster Akita?*
About Your Family
Do you have any children in your household?*
- Yes
- No
Please list below the name, gender and age of all children in your household (use + to add more people)*
Name Gender Age
Please list below the name, gender and age of all other residents in your household (use + to add more people)
Name Gender Age
About Your Pets
Do you currently have any animals in your household?*
- Yes
- No
Pets in Household*
Please specify the following information for each pet - name, species (dog, cat, etc.), breed, gender, age and whether the pet is spayed/neutered (S/N?) (use + to add more animals)
Name Species Breed Gender Age S/N?
Do you have a means to keep foster dog separate from the resident pets?*
- Yes
- No
Please explain below*
If some of your pets are not spayed or neutered, why not?
Have you ever had to relinquish a dog?*
- Yes
- No
If yes, list circumstances*
Have you owned a dog before?*
- Yes
- No
Breed(s) of dog owned
Have you owned an Akita before?*
- Yes
- No
Sex of Akita(s) owned*
- Male
- Female
- Both
Foster Akita Accommodations
Where will foster Akita stay while you are gone during the day?*
- Loose inside
- Crate
- Garage
- Fenced yard
- Loose outside
- Tied up inside
- Tied up outside
- Outside run
Where will the foster Akita be housed during the day when you are home?*
Where will the foster sleep at night?*
- Loose inside
- Crate
- Garage
- Fenced yard
- Loose outside
- Tied up inside
- Tied up outside
- Outside run
How long are you out of the home each day?*
How will the foster dog get daily exercise?*
If you need to go away for a few days, who will care for the foster Akita?*
About Fostering
Why do you want to foster?*
How did you hear about MARS?*
Do you have any preferences about the foster dog?*
(check all that apply)
- No preference
- Puppy (1-12 months)
- Young dog (1-3 years)
- Middle-age (4-8 years)
- Senior (9+ years)
- Male
- Female
- Other
If other, please explain
Do you have any experience in working with dogs in the following areas?
(check all that apply)
- Housebreaking
- Aggression
- Shyness
- Abused/neglected
- Puppymill dogs
- Physical handicaps (blindness, deafness, etc.)
- Other
If other, please explain
Is it ok if the dog is ___?
(check all that apply)
- Shy
- Not good with cats
- Not good with other dogs
- Dependent on people
- Independent from people
- Untrained
- Somewhat untrained
- Not housetrained
- In need of ongoing medical attention
Do you understand that the foster dog may not be housebroken and may need training?*
- Yes
- No
Would you be willing to foster a "special needs" dog?*
- Yes
- No
Would you be willing to foster/work with a dog that has behavioral problems such as shyness, fearfulness, barking or inappropriate jumping?*
- Yes
- No
In working with dogs, I consider myself*
- Experienced
- Somewhat experienced
- Novice
An Akita needs to be groomed/brushed periodically and has daily exercise requirements. Are you prepared to take on this responsibility?*
- Yes
- No
Do you own a crate?*
- Yes
- No
If no, are you willing to buy or borrow one to safely contain the foster Akita while in your home?*
- Yes
- No
Do you know how to crate train a dog?*
- Yes
- No
Do you know basic obedience techniques based on positive reinforcement?*
- Yes
- No
Please explain any training/experience you have had in handling dogs
Do you have a long-standing relationship with a vet?*
- Yes
- No
Do you think your vet would consider giving a discount for a rescue dog?*
- Yes
- No
Do you understand that you may need to make vet appointments, transport the dog to and from appointments and provide any support necessary in the event of an illness/surgery?*
- Yes
- No
Do you understand that you will be expected to keep the dog until placement?*
- Yes
- No
Do agree to allow a representative of MARS to visit your home by appointment?*
- Yes
- No
Please provide any other information which you would like MARS to consider in evaluating your application.
Conditions for Submission of Application
By mutual consent, this application is pending a pre-foster home check and periodic home checks thereafter. If the applicant should fail to pass the inspections, the dog will be returned to MARS if parties cannot agree upon corrections. MARS considers your privacy to be very important. Every effort will be made to respect a volunteer’s requests however MARS always reserves the right to contact a volunteer.

I am at least eighteen (18) years of age. In volunteering for Midwest Akita Rescue Society (MARS), I acknowledge that there are many risks associated with being around dogs, including though not limited to, the risks of being bitten, scratched, jumped on, knocked over, chased, tripped, infected with a disease, injured, frightened, receiving a life threatening injury, sustaining property damages, and incurring liability for a dog’s action.

I voluntarily assume these and all other risks both on behalf of myself, my children, my spouse, guests and others. I acknowledge MARS is a referral agency and they cannot make any guarantees about dogs and they cannot control or prevent dogs from causing injuries or damages. Acting on behalf of my family, children, guests, heirs, personal representative and myself, I forever release and discharge MARS, their members, officers, employees, directors and agents, and covenant to hold them harmless, from any and all liability, claims, damages, demands, costs, expenses, actions and causes of action including though not limited to negligence arising out of any dealings with MARS and any dogs.

MARS reserves the right to refuse membership to any applicant.

MARS has permission to use any pictures of volunteers taken at MARS events for placement in our publications, website or other outreach materials.

I agree that my contact information, including phone number(s) and email address(es) may be shared with other MARS volunteers and/ or possible adopters for the purpose of conducting rescue activities. I understand that my personal information will never be sold or used for any other purpose.

I have carefully read and understand this Agreement. I acknowledge MARS is relying on this agreement in accepting my offer to volunteer for foster home services. By signing below, I agree to the above.
Signature of Applicant*
By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.
Name Date
Signature of Co-Applicant*
By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.
Name Date

Name	Gender	Age

Name	Gender	Age

Name	Species	Breed	Gender	Age	S/N?

Personal Information

Employment Information

References

Veterinarians

About Your Home

About Your Family

About Your Pets

Foster Akita Accommodations

About Fostering

Conditions for Submission of Application

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