Find a Foster for My Pet

Midland County Pit Stop Owner Request for Temporary Foster Placement

* Indicates required field

Date *

Temporary Foster Placement Applicant Information

Name: First, Middle, and Last *

Birthdate *

Physical Address *

City *

State *

Zip Code *

Day Phone *

Cell Phone *

Email *

Reason for temporary foster placement *

Anticipated duration of temporary foster *

Please fill the portion out for any and all pets being temporarily fostered by Midland County Pit Stop.

PET PROFILE

Pet's Name *

Gender *

Weight *

Breed *

Age *

Spayed/Neutered? *

Microchipped? *

If so, Microchip Number *

Housebroken *

Yes No

Crate Trained *

Yes No

Socialized Regularly *

Yes No

Health Concerns *

Feeding Instructions/Food/Allergies *

Medications *

Favorite toy, game or treat *

Has your pet ever been aggressive or bit anyone? *

Yes No

If yes, please explain *

Is your pet afraid of car rides? *

Yes No

Is your pet afraid of the vet? *

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

Does your pet walk respectfully at your side on a leash? *

Yes No

If no, what sets him/her off? *

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 other behavioral issues *

I, (TYPE NAME BELOW) release temporary care of my pet(s), listed above, to Midland County Pit Stop in Midland, Michigan *

In placing my pet into temporary foster care with Midland County Pit Stop, I am still responsible for all liability and 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 or training as of the date listed below. ****PLEASE INITIAL**** *

Date *

Maximum contract length is 90 days from pet intake. If additional foster time is needed, it will be a decision made by Midland County Pit Stop Board of Directors. ******PLEASE INITIAL****** *

Date *

All pets must be spayed/neutered and UTD on vaccinations prior to intake. If they are not, owner must prepay for one or both to be updated. This amount is due in full upon intake. We also have a $5.00/day charge per pet which is also due in full at intake. ****PLEASE INITIAL**** *

Date *

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

Date *

If my pet(s) 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. ***********PLEASE INITIAL*********** *

Date *

I hereby relinquish temporary care of the above named pet(s) 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. ****PLEASE INITIAL**** *

Date *

Owner Signature *

Date *

Owner's Printed Name *

Co-Owner Signature *

Date *

Co-Owner's Printed Name *

Midland County Pit Stop Representative Signature *

Date *

Midland County Pit Stop Representative's Printed Name *

Submit

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

Temporary Foster Placement Applicant Information

Please fill the portion out for any and all pets being temporarily fostered by Midland County Pit Stop.

Midland County Pit Stop Owner Request for Temporary Foster Placement