The information provided in completing this profile will enable OPHS to find the most satisfying foster animal and experiences for you. Please be sure to complete all sections of the profile thoroughly and as honestly as possible. 1 Start 2 Page 2 3 Page 3 4 Page 4 5 Complete First Name * Last Name * Email * Phone (Home) * Phone (Cell) Street Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Other Do you: * - Select -OwnRent Landlord Name Landlord Phone How many adults live in the home? * How many children live in the home? * Children’s ages Are all household members familiar with dogs? * - Select -YesNo Is anyone in the home allergic to dogs? * - Select -YesNoPlease list the following information about pets currently living in your home:Type of AnimalAltered Y/N ?Date Last Vaccinated?Age? All Current Animals * Next Page >
