TEMPORARY PET HOUSING APPLICATION
Temporary housing for your pet may take some time to coordinate. We will find the best match for your pet, so please
provide as much detail as possible and please fill out the form completely. Thank you.
PERSONAL INFORMATION
Owner’s Name:
Home Phone:
Address:
Cell Phone:
City & State:
Zip Code
Email:
How did you hear about FurKidz 911 Connection? I was referred by:
 Seattle Humane Society
 Other:
 Seattle Cancer Care Alliance
 Seattle Children’s Hospital
Please explain the reason for needing temporary pet housing?
Have you exhausted all your options with family, friends, neighbors, co-workers, etc. before requesting
assistance from FurKidz 911 Connection? Please explain:
If you were not referred by a hospital or a local
support agency, can you provide medical
documentation for your request? Yes  No 
If no, please explain:
When do you need temporary pet housing? (specific
date or timeframe)
If medical, what hospital/facility will you be treated at?
When do you expect to return from
hospital/treatment?
When can we return your pet?
Are you able to keep in contact with us or your pet’s
foster family? Yes  No 
If no, please explain:
Are you able to transport your pet to the foster’s
home? Yes  No 
Are you able to pick up your pet after you are released
from the hospital/treatment facility? Yes  No 
Are you able to cover your pet’s supplies/expenses while in foster care?
 Food
 Grooming (if needed)
 Pet’s bed
 Destruction reimbursement
 Bowls
 Medical
 Unable to cover expenses
Do you have a  Dog
 Cat
 Bird
 Other
Pet #1 Information
Pet Name:
Microchip #:
Breed:
M
Age:
F
How long owned:
Description/Color/Markings:
Can you provide vaccination records? Yes  No 
Current Weight:
(your pet must be fully vaccinated before fostering begins)
Current Vaccines: Rabies ☐ DA2PP ☐
When was your pet’s last vet visit?
Bordetella ☐
 Spayed
 Neutered
 Unaltered
Will you need help to vaccinate or spay/neuter your
pet?
Yes  No 
For dogs: do you use a crate
while you are gone?
Yes  No 
(your pet must be spayed/neutered before fostering begins)
Provide your current vet & phone
number:
For cats: does your cat use the litter
box consistently? Yes  No 
Pet Profile
The following is to be completed by the pet owner and is to accurately describe the personality and current living
conditions of pet to be fostered.
People Interaction
Dog Interaction
Cat Interaction
☐People friendly
☐Likes other dogs
☐Likes cats
☐Shy towards new people
☐Shows dog aggression
☐Dislikes cats
☐Shows people aggression
☐Passive towards other dogs
☐Has never interacted with a cat
☐Pet has bitten a person before
☐Pet is nervous around small dogs
☐Pet dislikes small children
☐Pet is nervous around large dogs
☐Pet dislikes men
☐Pet is well-behaved in dog parks Hunting Instinct
☐Pet dislikes women
☐Pet shows desire to hunt small animals
☐Dislikes people coming through door
☐Pet is passive with small animals
☐Dislikes mail man
☐Barks at strangers
Behavior
Training
☐Pet shows food aggression
☐Pet dislikes being groomed
☐Pet is housetrained
☐Pet bolts from open doors
☐Indoor pet
☐Pet is crate-trained
☐Pet displays separation anxiety
☐Outdoor pet
☐Pet can be easily walked on-leash
☐Pet comes when name is called
☐Barks when alone
☐Pet dislikes/is uncomfortable in car ☐Fearful of loud noises
Additional information about your pet:
Do you have an additional
 Dog
 Cat
 Bird
 Other
(Note: we will try our best to keep your pets together)
Pet #2 Information (if applicable)
Pet Name:
Microchip #:
Breed:
Description/Color/Markings:
Age:
Can you provide vaccination records? Yes  No 
M
F
How long owned:
Current Weight:
(your pet must be fully vaccinated before fostering begins)
Current Vaccines: Rabies ☐ DA2PP ☐
Bordetella ☐
 Spayed
 Neutered
 Unaltered
When was your pet’s last vet visit?
Will you need help to vaccinate or spay/neuter your
pet?
Yes  No 
For dogs: do you use a crate
while you are gone?
Yes  No 
(your pet must be spayed/neutered before fostering begins)
Provide your current vet & phone
number:
For cats: does your cat use the litter
box consistently? Yes  No 
Pet Profile
The following is to be completed by the pet owner and is to accurately describe the personality and current living
conditions of pet to be fostered.
People Interaction
Dog Interaction
Cat Interaction
☐People friendly
☐Likes other dogs
☐Likes cats
☐Shy towards new people
☐Shows dog aggression
☐Dislikes cats
☐Shows people aggression
☐Passive towards other dogs
☐Has never interacted with a cat
☐Pet has bitten a person before
☐Pet is nervous around small dogs
☐Pet dislikes small children
☐Pet is nervous around large dogs
☐Pet dislikes men
☐Pet is well-behaved in dog parks Hunting Instinct
☐Pet dislikes women
☐Pet shows desire to hunt small animals
☐Dislikes people coming through door
☐Pet is passive with small animals
☐Dislikes mail man
☐Barks at strangers
Behavior
Training
☐Pet shows food aggression
☐Pet dislikes being groomed
☐Pet is housetrained
☐Pet bolts from open doors
☐Indoor pet
☐Pet is crate-trained
☐Pet displays separation anxiety
☐Outdoor pet
☐Pet can be easily walked on-leash
☐Pet comes when name is called
☐Barks when alone
☐Pet dislikes/is uncomfortable in car ☐Fearful of loud noises
Additional information about your pet:
Emergency Contact 1
Name:
Email:
Home Phone:
Address:
City:
Cell Phone:
State:
Zip:
Emergency Contact 2
Name:
Email:
Home Phone:
Address:
City:
Cell Phone:
State:
Zip:
EXPECTED RETURN DATE: _______________________________________________________
(Please note, we will need confirmation from the hospital or the support agency you are working with)
Things to consider:

What do you want us to do if your pet is injured or ill? What if it is life threatening?

What do you want us to do if the illness or injury creates an unexpected high vet bill (or estimate)?

We don’t like to ask this question, but, in the worst case scenario, if something were to happen where
you are not able to return and retrieve your pets, what would you like for us to do?
Additional information you would like to share about your situation:
I certify that the above information is true and correct to the best of my knowledge.
Applicant Signature:
Date:
Email your completed form to info@furkidz911.org or fax to 866-611-5713
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FOR OFFICE USE:
 Accepted
 Rejected
Foster parent(s) assigned
NOTES - Additional Needs or Comments:
 On hold
Reviewed By:
Foster parent’s contact information
Date:
Start date: