APPLICATION Thank You for Supporting PACT and Our Clients’ Beloved Pets Application Save my progress and resume later | Resume a previously saved form Resume Later In order to be able to resume this form later, please enter your email and choose a password. Your Email: A Password: Confirm Password: IMPORTANT: You will see at the top right of this form, that you are able to save this at any time and come back to it when it is convenient. It is our recommendation that you save it after answering the first question and save it a couple of times throughout the process. This way, if something happens to your connection you will not have to start over. Are you applying to... (select all that apply)I want to be a PACT Foster HomeI am in need of a PACT Foster HomeI want to volunteer Personal Information First Name MI Last Name Primary Applicant's Birth Month Primary Applicant's Birth Day Primary Applicant's Age Primary Applicant's Email Cell Phone & Texting Work Phone Work Email Alternate Email Home Phone (landline) Contact Information What is your first preference for communication from usPlease select... Cell Phone Text Work Phone Home Phone (landline) Email What is your second preference for communication from usPlease select... Cell Phone Text Work Phone Home Phone (landline) Email What is your third preference for communication from usPlease select... Cell Phone Text Work Phone Home Phone (landline) Email Address Line 1 Address Line 2 City StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Postal Code CountryPlease select... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands ( Islas Malvinas ) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands ( British ) Virgin Islands Wallis and Futuna Yemen Zambia Zimbabwe If you have a Facebook or online profile, please share it with us here: How did you hear about PACT? Website/Search Engine Dogs on Deployment Facebook Twitter Youtube Family or Friend TV/Cable News Community Event Advertisement Email/Newsletter Newspaper Story Magazine Craigslist Other If magazine, please tell us which one: If other, please describe: Will you foster dogs?YesNo Will you foster cats?YesNo What other animals would you be willing to foster?BirdsRodentsHorsesReptilesOther If other or want to be more specific, please explain: Please choose what best fits why you want to foster -select all that apply:I love PACT's mission and want to be a part of it by fostering a petI love animals of all typesI love dogsI love catsI can not or do not want to adopt a pet permanently, but enjoy their company My family wants to get a pet and I thought this would be a great way to see if they are up for the challenge while at the same time helping someone in needI have fostered before and would love to do it againI have military connections myself and want to help military personnel and their families. I have had hospital experiences myself and want to help hospital patients and their familiesOther If other, please tell us more: Please list all people living in the house full or part time - including yourself First Name Last Name Age Relationship to primary applicant Self Spouse/significant other Child/grandchild Parent Roommate/tenant Other If other, please explain: Please tell us about this person's animal care experience:Experienced pet ownerThis will be my/their first petFostered pets beforePet TherapyPet trainingWorked in a rescue/shelter, vet office, training facility, pet grooming facility and/or boarding facilityExperience with abused, special needs, or rescued pets Other If other, please describe: If you have experience with abused, special needs, or rescues, please tell us more Are you willing and able to medicate your foster?Yes- I Have significant experience medicating animalsMaybe - depends on the medicationNo We cannot completely guarantee an animal is housebroken. Also sometimes pets will have accidents just because of the upset of being separated from their owners - but it is usually temporary. Are you equipped to handle these kind of situations with love and patience?YesI have never had to house train but I am willing as long as I have some guidance.No Do children visit your home?YesNo What age are the children who visit your home?Under 55-9 10-1314+ Do you live in a House Apartment Townhouse Condo Duplex Other If other, please explain: Do youOwnRentLive with ParentsOther If other, please explain: Does your lease allow animals?YesNoUnsure Please give us landlord contact Information so we can confirm that your lease allows pets: Household settingRuralSuburbanUrban Is your yard fully fenced?YesNo Choose what best describes what your fence is made of - select all that applyMetalChain LinkMeshStuccoWoodVinyl Invisible Fence If need to give more details please tell us here: Choose what best describes the height of your fence The fence is under 4 ft tallThe fence is 4 ft to 5 ft tallThe fence is 5 ft to 6 ft tallThe fence is over 6 ft tall Choose what best describes what size dog is appropriate for your fenceThe fence is safe for all size dogsThe fence is safe for small dogsThe fence is safe for small to medium dogsThe fence is safe for medium to large dogs onlyThe fence is safe for large dogs only On average how long will the foster dog(s) be outside unsupervised?1/2 hr to 1 hr2 hrs to 3 hrs4 hrs to 5 hrs6 hrs to 7 hrs8 or more hoursAs long as they wantThey will never be outside unsupervised If need to give more details please tell us here: On average how long will the foster pet(s) be left alone in the home?2 hrs to 3 hrs4 hrs to 5 hrs6 hrs to 7 hrs8 hrs to 9 hrs10 hrs to 12 hrs Will someone come in to visit, walk the dog and/or feed the dog daily, if he/she will be alone for longer than the pet owner's requirement?YesNo If yes, please give us more information: Does your house have a pool?NoYes, but the pets do not have access unless they are being supervised.Yes, and the pets will have access to it if they are in the yard If the cat(s) is going to be left alone for more than 9 hrs, will someone come in to visit and/or feed the cat daily?YesNo Do you have a dog door in your home?YesNo Please check all that apply.The Doggy Door leads into a fenced areaIt is unlocked at all timesIt is locked at night, unlocked during the dayIt is locked during the day, unlocked at nightOther If other, please explain Do you have steps in your home?YesNo If yes, please choose all that are appropriateUnder 5 steps6 steps or moreMore than one flightA low mobility pet can be accomodated What is the minimum length of time you are willing to foster? No less than 1 to 2 monthsNo less than 3 to 4 monthsNo less than 5 to 6 monthsNo less than 1 year No less than 2 yearsI don't have a minimum time frame in mind What is the maximum length of time you are willing to foster? No more than 2 monthsNo more than 3 to 4 monthsNo more than 5 to 6 monthsNo more than 8 months to a yearNo more than 15 to 16 monthsI don't have a maximum time frame in mind Are there any dates you are unable to foster? Are you willing to foster an animal of any age?YesNo If no, what age dog are you willing to foster? Select all that apply.Young puppy (under 1yr old)Puppy (1 to 2 yrs old)Young dogAdult dogSenior Citizen dog If no, what age cat are you willing to foster? Select all that applyKittenMiddle aged catSenior Citizen cat What gender of pet will you foster?MaleFemaleEither gender is fine What size dog are you willing to foster? Select all that apply.SmallMediumLargeExtra LargeAny size dog will be welcome What energy level of pet are you willing to foster? Select all that apply.High MediumLowAny energy level is welcome What coat length do you require? (select all that apply)ShortLong that needs daily brushingLong that doesn't need daily careNon shedding (this may still need occasional trips to the groomers)Hypo-allergenicAny coat length is welcome What type of personality would you like the foster dog to have? Select all that apply. Loves to play with anybody Loves to play with other dogs Interacts ok with other dogs Loves to play with cats Interacts ok with cats Loves to play with young children Interacts ok with young children Loves to play with children of all ages Interacts ok with children of all ages Quiet and independent Affectionate High maintenance Low maintenance Barking is ok but within reason No barking Any personality is welcome What type of personality would you like the foster cat to have? Select all that apply. Loves to play Loves to play with other cats Interacts ok with other cats Loves to play with dogs Interacts ok with dogs Loves to play with young children Interacts ok with young children Loves to play with children of all ages Interacts ok with children of all ages Quiet and independent Affectionate High maintenance Low maintenance Any personality is welcome Do you have any breed restrictions? Select all that apply.German ShepherdsRottweilersDobermansPit BullsStaffordshire TerriersBull TerriersAmerican BulldogOther breed restrictionsNo restriction If other breed restrictions, please explain: Do you require a foster animal that is: (select all that apply)Child FriendlyCat FriendlyDog FriendlyApartment FriendlyFarm FriendlyDeclawed(cats)No requirements Are you willing to foster: Select all that apply.Alpha dogsHighly active dogsNone of the above Are you willing to foster multiple dogs from the same family?YesNoMaybe Are you willing to foster multiple cats from the same family?YesNoMaybe Are you willing to foster multiple animals from different families?YesNoMaybe Are you willing to take your foster pet to vet appointments as needed by the animal?YesYes, but I don't have transportation thereNo If no, please explain: Are you willing to use a crate for a dog?Yes, I only want crate trained dogsYes, but not requiredNo. I am not comfortable with crating dogs How do you prefer to exercise your foster? Select all that are acceptable.Gentle walksBrisk walksJoggingDog parksPlaying in the yard with family member(s)Playing in yard in with other petsSwimmingExercise will be dailyExercise will be a couple times a weekExercise will be occasionallyDoggy DaycareOther If other, please give us some more information: How do you expect the owner to cover pet care expenses? Select all that are acceptable.Monthly reimbursements through PayPalMonthly stipend through PayPalOwner buys food online and has shipped to foster homeDonate reimbursement amount to PACT Are you willing to have a PACT Volunteer visit you in your home to do a Home Check?YesNoUnsure If no or unsure, please explain: Do you currently have any animals in your home? YesPrevious pet owner, currently no petsNo Please tell us more about your past pets: Please List all pets living in your home. TypeDogCatReptileBirdFarm AnimalRodentOther Name Breed or type If other, please tell us more: AgeUnder 6 months6 months to 1 year18 months to 2 yrs3 to 6 yrs7 to 10 yrs11 to 15 yrs16 yrs + GenderMaleFemale How does your pet react to other dogs in their house? Select all that apply:Very friendly and playfulFriendly and playful once he/she acclimates to the other dogNeutral once he/she acclimates to other dogKeeps its distanceTerritorialCouldn't care lessCan become aggressive or show other highly negative behaviorUnknown How does your pet react to other cats in their house? Select all that apply:Very friendly and playfulFriendly and playful once he/she acclimates to the other catNeutral once he/she acclimates to other catKeeps its distanceTerritorialCouldn't care lessCan become aggressive or show other highly negative behaviorUnknown Is your pet good with: Select all that apply.Little dogsBig dogsCatsOther animalsMedium dogsFemale dogsAlpha dogsPlayful/active dogsSenior dogsUnknown If more details are needed, please explain your pet's behavior with other animals: Is your pet spayed or neutered?YesNoUnknown Is your pet up to date on vaccines?YesNo We require all animals in the home to be up to date on core vaccines (rabies and distemper). Why is your pet not vaccinated and when do you plan to get their shots updated? Is your pet being treated monthly for heart worm?YesNo Veterinarian Information, please make sure you give your veterinarian permission to speak with us (even if you don't have a pet now, we like to use your past veterinarian for a reference): Veterinarian name Phone Would you be willing to have a PACT Home Visit Volunteer call your veterinarian for a reference check? YesNo If no, please explain: We must have the name of the nearest/best 24-hr emergency veterinarian near your home? If you are unsure please use this link to find the one nearest to you - http://www.vetlocator.com/hotline.php What is the phone number of the nearest/best 24-hr emergency veterinarian near your home? What is the name of the closest kennel for dogs near your home? What is the phone number of the closest kennel for dogs near your home? What is the name of the closest kennel for cats near your home? What is the phone number of the closest kennel for cats near your home? Please provide 2 references who you have known for at least 1 year and that can speak to your animal care experience to help facilitate the PACT Home Approval Process (veterinarians, groomers, trainers, neighbors, co-workers, friends) as well as 3 photos of your home: yard plus 2 inside of your home where the foster(s) would be spending most of the time. Reference 1 First Name Last Name Phone Email Relationship? Select all that apply. Friend Co-Worker Veternarian Family member Other If other, please explain: Reference 2 First Name Last Name Phone Email Relationship? Select all that apply. Friend Co-Worker Veternarian Family member Other If other, please explain: Please upload a photo of your yard: Please upload a photo of the inside of your home where the pet will stay: Please upload a second photo of the inside of your home where the pet will stay: While you are fostering a pet or waiting for a foster pet would you be willing to volunteer in other ways?YesYes, but not until our foster pet is reunited with its owner(s)MaybeNo Foster Home Needed By: Expected Return Date: Length of Foster Care in Months (please enter a number only, no text): Please explain how accurate your return dates are: How sure are you that you will be able to reunite with your pet?I am positiveI feel mostly sureI am not sure If you are not positive about reuniting with your pet, please tell us why: Owner's Birth Date Martial StatusSingleMarriedDomestic PartnershipWidowedDivorced Which PACT program are you applying for? Military programVeteran programMilitary hospital/medical crisisVeteran hospital/medical crisisHospital/medical crisisOther If other, please give us some more information. Have you checked with all family, reliable friends, neighbors, co-workers, etc for a foster home, before coming to PACT?YesNo What is the name of the medical facility where you will be a patient? What is the diagnoses you are being treated for? What is the expected outcome after your treatment? What Branch are you serving in?Air ForceArmyNavyMarinesNational GuardReservesCoast Guard If Reserves, which branch? What Branch did you serve in?Air ForceArmyNavyMarinesNational GuardReservesCoast Guard If Reserves, which branch? What is your rank? What was your rank? Where are you being deployed - please include name of base and country? Can you give any other details about your situation, such as where you are going, or why you have been unable to find a foster for your pet? What will you do with your pet if PACT cannot place them in a foster home? Please provide more details about your reason for needing animal foster care: Can you continue regular contact with you pet's foster family? YesNo If no, please explain: Pet related expenses you can cover while your animal is in foster care (select all that apply):FoodMedicalDestructionAccessoriesGrooming/BoardingAll expensesUnable to cover expenses If you are unable to cover some or all of your pets expenses, please give details of what you are/aren't able to cover, and why. Please note that most foster families require owners to cover all costs of care: How do you plan to cover your pets expenses while in foster care?Monthly reimbursement through PayPalMonthly stipend through PayPalBuy food online and have shipped How far are you willing and able to drive, one way, to transport your pet to an Approved PACT Foster Home?No more than 1 to 2 hrs one wayNo more than 3 to 4 hrs one wayNo more than 5 to 6 hrs one wayNo more than 7 to 8 hrs one wayNo more than 1 state awayNo more than 2 states awayNo more than 3 states awayI will drive however long it takesI do not live in the Greater Philadelphia area, but I am willing to drive my pet there.I am unable to drive my pet any distance If we do not have checked foster homes in your area, are you interested in being connected with an Unchecked Home? These homes have filled out the foster home application but have not completed the home approval process. PACT cannot endorse and may not be able to assist with emergencies in unchecked homes.YesNoUnsure Pet Information: (More than one pet? - You will have an opportunity to add as many pets that need a foster home at the end of this section.) Pet Name (you will have option to add each pet individually) Pet details Address of pet if it is currently different than owners Address Line 2 City StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Postal Code CountryPlease select... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands ( Islas Malvinas ) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands ( British ) Virgin Islands Wallis and Futuna Yemen Zambia Zimbabwe Type of Pet Dog Cat Rodent Rabbit Horse Other If other, please put type of pet: Pet Breed (enter unknown if you don't know the breed) Pet GenderFemaleMaleunknown What is your pets age (enter number only - no text)? Pet approximate weight (only enter the # of lbs no text please): How long has your pet been your companion animal? Is your pet microchippedYesNo Microchip Number Is your pet spayed/neutered?YesNoUnsure Are you able/willing to get your pet spayed/neutered before being taken to a foster home? Please note most foster families will require this.YesNo If no, please explain Is your pet current on all vaccinations?YesNoUnsure If yes, then what is the date when their next vaccine is due? If the date when their next vaccine is due is during the time of fosteringI will be able to take my pet for their vaccinesI will need the foster to take my pet for their vaccinesI am not sure - I would like to discuss this with the foster at that time Are you able/willing to get your pet vaccinated before being taken to a foster home? Please be aware that there are certain vaccinations that PACT requires before placing a pet in a foster home.YesNo If no, please explain Is your pet on tick/flea preventative?YesNo If yes, what type? Are you willing and able to put your pet on an effective tick/flea preventative before being transferred to the foster home? Please note most foster families will require this.YesNo If no, please explain: Is your pet currently on a heartworm preventative?YesNo Are you willing/able to cover the cost of a heartworm test and monthly preventative. Please note many foster families will require this.YesNoUnsure If no or unsure, please explain: Does your pet have any known allergies?YesNo If yes, please explain: What is your pet's reaction to cats?Unsure, they have never met a catNot safe, they will chase and hurt themThey will chase and try to play but not hurt themThey will be interested but not chase them They ignore cats Pets reaction to DogsUnsure, they have never met a dogNot safe, they will chase and hurt themThey will chase and try to play but not hurt themThey will be interested not not chaseThey ignore dogs Has your pet shown aggression or fear towards or may be unsafe around (select all that apply)Big dogsLittle dogsHighly active dogs Dominant (Alpha) dogsMale dogsFemale dogsCatsChildren Age 0-5Children Age 6-12Children Age 13-16Other animalsMen with BeardsMenWomenTeenangersOtherNone of the above If other, please explain: Please explain what type of fearful or aggressive behaviors may your pet show and under what circumstances? Would you describe your pet as (select all that apply):Dominant/AlphaSubmissiveGood with male dogsGood with female dogsGood with some dogs, but not othersNeutral/Good with all dogsFearful/reactiveDefensiveNone of the above Has your pet ever lived with (select all that apply):Children 0-5Children 6-12TeenagersOther catsOther dogsFarm animalsNone of the above Does your pet have food aggression or need to be fed in a separate room?Yes SometimesNoI don't know Please give details: Is your pet used to (select all that apply):Apartment LifeHouse without yardHouse with a large fenced yardHouse with a small fenced yardHouse with an unfenced-yardLiving on a farm During the day, does your pet live:Mostly indoors?Mostly outdoors?Combination of indoors and outdoors? During the night, does your pet live:Outside at nightInside at night On an average, how long can your pet be left alone in the home without a bathroom break?2 hrs to 3 hrs4 hrs to 5 hrs6 hrs to 7 hrs8 hrs to 9 hrs10 hrs to 12 hrs On an average, how long can your pet be left outside in a fenced area unsupervised? 1/2 hr to 1 hr2 hrs to 3 hrs4 hrs to 5 hrs6 hrs to 7 hrs8 hrs or moreI do not ever want my pet unsupervised while outside How is your pet used to being exercised? (select all that apply)Let out in yard, supervisedLet out in yard, unsupervisedTaken on short walksTaken on long (>1mi) walksTaken on runs or bike ridesPlaying at the dog park or dog daycareDoes not need to be exercised How often does your dog go to dog parks or doggy day care? Is your pet used to a fenced yard? YesNo Does your pet jump or dig under fences?YesNo Choose what best describes the height of fence your pet requires: A fence that is under 4 ft tallA fence that is 4 ft to 5 ft tallA fence that is 5 ft to 6 ft tallA fence that is over 6 ft tall If yes, please tell us more Are you comfortable with your pet using a Doggy DoorOnly if the Doggy Door leads into a fenced areaOnly if it is locked at night, unlocked during the dayOnly if It is locked during the day, unlocked at nightNo I am not comfortable with a doggy door Is your pet safe around a pool?YesYes, but needs supervisionNo, my pet can not swimI don't know Where does your pet go to the bathroom (select all that apply):OutdoorsIndoor wee-wee padsLitter boxCurrently trainingNone of the above How often does your pet miss the designated bathroom spot?NeverRarelyOnly under certain circumstances Under what circumstances (stress, marking, too long alone, etc)? Is your pet crate-trainedYesNoHave crate, currently training Can your pet's crate be transported to the Foster Family along with the pet?Yes if I transport my petNo if I transport my petDepends on who and how my pet is being transported Is your pet trained to walk quietly on a leash?YesNo - pulls heavily on the leashHave leash, currently trainingNot leash trained at all Does your pet try to bolt or escape from the house through doors or windows?YesNo If yes, please explain If your pet is off-leash, outside, will they come when called? My pet will come if called in a fenced yardMy pet will come if called in a rural un-fenced areaI wouldn't count on my pet to come if calledNo Has your pet bitten or scratched anyone within the last 6 months? YesNo If yes please give details: Has your pet had any destructive tendencies when stressed? Do they howl or bark when left alone, chew, growl, or exhibit separation anxiety? Please give details: Does your pet chew on wires, shoes, toys, remote controls, etc? How much noise does your pet make, and under what circumstances? Describe your pets energy level:High energy/HyperMedium EnergyLow energy Does your pet have any food sensitivities that you are aware of?YesNo If yes, please list foods: Does you pet have any special health needs or medications?YesNo If yes, please list them, how often they are given and approximate monthly cost Where does your pet sleep?In their crateOn my bedOn their own bed, on floorOn the floor without a bedAnywhere they want Does your pet jump up when meeting new people?YesNo Is your pet de-clawed or de-barked? Please choose all that applyYes my pet is de-clawedYes my pet is de-barkedNo What brand of food do you feed your pet? How sensitive are they to diet changes?Very sensitiveSometimes a bit sensitiveNot usually sensitive Tell us something cute or amazing about your pet? What makes them special? What tricks does your pet obey? Eg: sit, stay, speak Please upload a clear picture of your pet(s). Please describe the perfect foster family for your beloved pet: Name of Veterinarian Clinic Phone Whose name (yours or some else') is your pet under at vet? Is your pet covered by pet insurance?YesNo If yes, what is the name of the insurance carrier? What is the policy number? What is the renewal date? Insurance carrier's phone number Emergency contact if we cannot get in contact with you? This will be your Point of Contact (POC) person who also will be responsible for taking possession of your pet if you are unable to do so on the appointed date. POC Name POC Relationship POC Phone Number POC Alternante Phone Number POC Email POC Address Line 1 POC Address Line 2 POC City POC StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau POC CountryPlease select... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands ( Islas Malvinas ) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands ( British ) Virgin Islands Wallis and Futuna Yemen Zambia Zimbabwe POC Postal Code It is because of our volunteers that we can offer you a safe and loving home for your pet in your time of need. Would you like to "Pay It Forward" while your pet is being fostered or once you and your pet are reunited?YesNoMaybe Are you employed?YesNo Occupation Employer/Company Name Have you ever volunteered before?YesNo If so, how and where? Are you willing and able to transport animals?YesNo If yes, do you have access to a reliable vehicle?YesNo Days of the week available (select all that apply):MondayTuesdayWednesdayThursdayFridaySaturdaySundayAny day works for me Time of day preferred (select all that apply):Week day morningsWeek day afternoonsWeek day eveningsWeekend morningsWeekend afternoonsWeekend eveningsAny time of day How many hours are you willing to volunteer?1-2 hrs a week3-5 hrs a week6-10 hrs a week10 + hrs a week1-2 hrs a month3-5 hrs a month6-10 hrs a month 10+ hrs a month T- Shirt Size:SMLXLXXL Please provide 2 references who you have known you for at least 1 year and that can speak to your animal care experience and volunteer experience(veterinarians, groomers, trainers, neighbors, co-workers, friends): Reference 1 First Name Last Name Phone Email Relationship? Select all that apply. Friend Co-Worker Veternarian Family member Other If other, please explain: Reference 2 First Name Last Name Phone Email Relationship? Select all that apply. Friend Co-Worker Veternarian Family member Other If other, please explain: PACT would not be able to do what we do without our volunteers. Below are some of the areas we would love to have your help. Select all that you would like to help us with.Home Visit VolunteerCoordinating fundraising eventsFundraising event volunteerRepresenting PACT at an outreach eventHelp with crowdfunding and other fundraising avenuesDog trainingBoarding cats or dogs until a foster is foundHelp with transporting pets, such as taking pet to new foster or back to pet ownerRepresenting PACT at pet drop offs and reunionsVideographers & photographers for reunions and other special eventsVideo editingGraphic designers who will help with flyers, emails, capital campaign, etc.Helping with office duties such as simple google search projects, spreadsheets (Excel), data entry (Salesforce), etc. either in the PACT office in suburban Philadelphia or from homeVolunteer & Outreach coordination in your immediate areaSpreading the word to local hospitals, dog trainers, boarding facilities, military events, local media outlets and the general public.Program development and implementationMedia outreach such as writing articles, contacting media outlets and/or media insider or blogger to do a story on PACTOther If other, please tell us how you feel you can help PACT: PACT is always looking for service providers that are willing to offer nonprofit discounts or help with our programs. We would be very grateful if you could put us in contact with any of the following services. Please check off all that apply. Local veterinarians and/or emergency animal facilitiesPet boarding facilities/kennel/daycare facilitiesProfessional dog trainersPromotional items or services such as t-shirts, printing, video editing etcEducators and/or Social Workers that can help with our Companion Animal Education ProgramPet supplies vendor Please feel free to give us some more information PACT is a non-profit organization that depends solely on donations and grants from our generous supporters. Would you like to learn more on how you can help PACT in this way?Absolutely! Please tell more more about making recurring monthly, quarterly or annual donations.Absolutely! Please tell me how I can make a one time donation.Absolutely! And my employer has a matching donation program. My employer has a volunteer reward program and will donate to PACT as my charity of choiceI have a potential corporate donor that I would like to introduce you to.Sorry, not at this time, but please reach out to me later.Sorry, not at this time. Please feel free to give us some more information PACT would be thrilled if you have any suggestions or contacts on how we can continue to spread the word about our services.Social workers or other professionals at hospitals and/or rehabilitation facilities.Military personnel, Veterans Administration personnel, or Department of Defense personnel so PACT can provide help and resources to the soldiers and their families during deployment or or lengthy training. Please give us some more information or suggestions Please use this space to give us any further information you feel is pertinent to your application: A PACT staff member will reach out to you shortly. Thank you so much for taking the time to complete this application. We look forward to working with you soon.Warmly, Buzz Miller, Founder and President By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully. I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any PACT for Animals (henceforth "PACT") animal(s) fostered by me to PACT. I certify that the above information is correct, and I understand that the information can be verified. I understand that by submitting this form electronically, I agree to release and covenant to hold harmless PACT and its members from any claims, damages, costs or actions incurred because of the care or actions of the foster animal(s) while in the care of the foster household. I accept full responsibility for the animal(s) actions at all times, and release PACT from any liabilities or damages that may be incurred because of our household fostering such animal(s). I agree to have PACT complete reference call checks and conduct a home visit inspection in order to approve my foster family application. I agree that if I am unable to foster the animal(s) for any reason I will notify PACT of my intent to return the animal(s) to PACT's care and agree to give PACT a two week period to try and find another suitable foster for the animal(s). Please type your name below. By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully. I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the denial of participation in any PACT for Animals (henceforth "PACT") animal foster program(s) or services. I certify that the above information is correct, and I understand that the information can be verified by PACT. I understand that by submitting this form electronically, I agree to release and covenant to hold harmless PACT and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the foster animal(s) and or foster household. I accept full responsibility (as stated above) for animal(s) cost of care while in foster care, and release PACT from any liabilities or damages that may be incurred because of fostering such animal(s). I agree to have PACT complete reference call checks, if desired by PACT. I agree that I have provided full details about my pet, and understand that PACT for Animals will assist me to the best of their ability without any guarantee in locating an appropriate and safe environment for my pet. Please type your name below. Is it OK to contact you in the future? Because we know you are busy, PACT will never burden you with too many emails. YesNo Save my progress and resume later | Resume a previously saved form Contact Information Donate Be a Foster Find a Foster
