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 Canine Foster Application ***All questions with asterisks must be answered or filled in to move on to the next page*** Name * Email * Primary Phone * 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 * Do you: * - Select -OwnRent Do you live in a: * - Select -HouseApartmentMobile Home5th WheelDuplex Please Provide Landlord Name and Phone Number * Your Age: * - Select -Under 1818 to 3435 to 5455 to 7475 and over How many adults live in the home? * How many children live in the home? * Children’s ages Are all household members familiar and comfortable with dogs? * - Select -YesNo Is anyone in your home allergic to dogs? * - Select -YesNo How long are you willing to foster dog/puppy? * 1-7 Days 2-6- Weeks A few months As long as it takes to find a permanent home Describe any pets living in your home: (Type of animals, male/female, spayed/neutered, age, date last vaccinated) * How would your pet(s) interact with a foster dog/puppy? * Next Page >
