Currently this program is only available toresidents of Newaygo County Senior to Senior Foster Application Your Name: Name of spouse/significant other/roommate: Address: City and Zip: Phone: Email: Secondary Contact Name: Their Phone: Are you 55 years of age or older? Yes No Do you: Own your homeRent your homeRent a roomOwn/Rent CondoRent an apartmentLive with friendsOwn/Rent a mobile homeRent a mobile homeReside in an assisted living facilityLive with roommate(s)Live with children or other family members If you rent: Landlord's Name: Landlord's Phone Number: Does your landlord allow pets? Yes No Any restrictions? How long have you lived at your present address? How many people live in your home and their ages? Is anyone in your household allergic to cats? Yes No NOTE: For client privacy reasons, many veterinary offices will not release personal information. For this reason, YOU MUST CALL YOUR VETERINARIAN to request the release of all vet care records to Bellwether Harbor for all current and past pets. If we are unable to access this information, your application will not be processed. If yes, how will you manage these allergies? Name of your veterinarian(s) & Phone: Clinic Name and Address: Name(s) and Address on the account: Bellwether Harbor staff strive to do our best to match the personality of the foster cat to the human(s) in the home. Please indicate your preferences: Sex: Male Female No preference Size: Small Medium Large No preference Age: Young Adult Adult Senior No preference Other preferences: Temperament preferred (check all that apply) Quiet Gentle Shy Lap cat Active Independent Assertive Playful No preference Other I would like the foster animal to get along well with: Children Adults Do all housemates want to foster a cat? What is the longest period of time the animal will be left alone without supervision? What shifts do you and other adults work? Where will the cat be kept during the day? (kennel, in bedroom, etc.) Where will the cat be kept during the night? (kennel, in bedroom, etc.) Are you willing to make a commitment to: Correct possible behavior concerns? YesNoI have questions about this Are you willing to make a commitment to: Offer daily socialization and play time? YesNoI have questions about this Are you willing to make a commitment to: Clean the litter box daily? YesNoI have questions about this Are you willing to make a commitment to: Brush/groom regularly? YesNoI have questions about this Note: cats fostered through Bellwether Harbor's Seniors For Seniors Program MUST be kept indoors only. What is your main reason for fostering a cat? What do you feel you have to offer for a foster cat? Past pet history. Tell us about the pets you've owned in the last 5 years. Have you ever taken an animal to a shelter? If yes, which shelter? When and what were the circumstances? How did you find out about Bellwether Harbor's Seniors For Seniors Foster Program? • I hereby permit the Bellwether Foundation or its appointed representative to call my references and anyone he/she may deem necessary to determine how I care for or have cared for my companion animals. • I hereby release to the Bellwether Foundation or its appointed representative permission to attain all veterinary records for the animal(s) I own or have owned. • I understand that the animal I am interested in fostering may require medical treatment and I will contact Bellwether Harbor IMMEDIATELY for assistance. For after-hour emergency assistance please contact a Bellwether Animal Specialist per instructions given at the time of placing the foster animal. • If behavior concerns arise, I will promptly contact Bellwether Harbor for consultation and possible return of the foster animal. I certify that all the information in this application is true and correct to the best of my knowledge and belief. I understand that any false information I supply may void my opportunity to foster for Bellwether Harbor. YesNo If you are human, leave this field blank. Submit
