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Midland County Pit Stop Owner Request and Agreement for
Temporary Foster Placement

* Indicates required field

Date *

Name *

First

Last

Physical Address *

City *

Cell Phone *

State *

Zip Code *

Email *

Reason for temporary foster placement *

Anticipated duration of temporary foster *

I, ________________________________________, release temporary possession of my dog(s)/cat(s) to Midland County Pit Stop, Midland, MI (herein referred to as Midland County Pit Stop) as of (date) ___/___/_____. The breed and description of my pet are as follows:

Pet's Name *

Breed *

Description *

Age *

In place my pet into temporary foster care with Midland County Pit Stop, I am still responsible for all liability, financial responsibility resulting from my pet's health, behavior or training. In placing my pet into temporary foster care with Midland County Pit Stop, I am allowing Midland County Pit Stop to make decisions regarding my pet's health, behavior and/or training as of the date listed above.

Initial Here *

* 14 days from the date of this contract, or from the date Midland County Pit Stop vets your pet, whichever comes first, a payment schedule will be created and payments will be due every two weeks until paid in full

*Balance must be paid in full for pet to be returned to owner

Contract length is 90 days from date of contract

*If additional foster time is needed, it will be a decision made by Midland County Pit Stop Board of Directors

*Weekly check-ins are required (i.e. text, phone call or FB Messenger) to keep open communication and updates on the pet and create a caring environment for all involved.

If my pet is determined to be too dangerous to foster temporarily or becomes ill or injured to a level that is deemed life threatening by Midland County Pit Stop's vet, Midland County Pit Stop reserves the right to make all decisions pertaining to my pets treatment.

Initial Here *

I hereby relinquish temporary care of the above named pet to Midland County Pit Stop. I hereby certify that I am the legal owner of this pet and have provided vet records and county registration as proof of sole ownership or have supplied a signature of a co-owner. I hereby certify that this pet is not dangerous, vicious and has no bite record. I have not willfully concealed any information about the pet that might indicate such behaviors. I further understand and agree that U received no money or any other compensation as a result of this temporary foster placement. I hereby temporarily relinquish all physical care to said pet and understand that this temporary foster place is legally binding. Breach of this contract, could result in permanent surrender of said pet to Midland County Pit Stop. I understand that if I willingly lied or mislead any truths of said temporary foster placement animal, i will be held responsible for any legal ramifications.

Owner Signature *

Owner's Printed Name *

Date *

Co-Owner Signature *

Date *

Co-Owner's Printed Name *

Midland County Pit Stop Representative *

Midland County Pit Stop Representative's Printed Name *

Date *

Please fill this portion out for you pet being temporarily fostered by
Midland County Pit Stop, Midland, MI

PET PROFILE

Pet's Name *

Gender *

Breed *

Weight *

Age *

Spayed/Neutered? *

Microchipped? *

Microchip Number *

Housebroken? *

Crate Trained? *

Socialized Regularly? *

Bite Record or Aggression history? *

Please explain any bite record or aggression *

Health Concerns *

Favorite toy, game or treat *

Feeding Instructions/Food/Allergies *

Medications *

When left alone, does your pet bark/cry? *

Yes No

Scratch at things? *

Yes No

Is your pet afraid of strangers? *

Yes No

Is your pet afraid of being left alone? *

Yes No

Is your pet afraid of the vet? *

Yes No

Is your pet afraid of loud noises? *

Yes No

Does your pet do well with children? *

Yes No

Does your pet do well with dogs? *

Yes No

Does your pet do well with cats? *

Yes No

Has this pet every been cared for outside your home by a sitter, kennel or dog walker? *

Yes No

If so, please indicate name and contact number *

What commands does your pet know? *

Please indicate any behavioral issues *

Midland County Pit Stop Owner Request and Agreement for ​Temporary Foster Placement

Please fill this portion out for you pet being temporarily fostered by ​Midland County Pit Stop, Midland, MI

Midland County Pit Stop Owner Request and Agreement for
Temporary Foster Placement

Please fill this portion out for you pet being temporarily fostered by
Midland County Pit Stop, Midland, MI