MIDLAND COUNTY PIT STOP
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Midland County Pit Stop Owner Request for Temporary Foster Placement
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Indicates required field
Date
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Temporary Foster Placement Applicant Information
Name: First, Middle, and Last
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Birthdate
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Physical Address
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City
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State
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Zip Code
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Day Phone
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Cell Phone
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Email
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Reason for temporary foster placement
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Anticipated duration of temporary foster
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Please fill the portion out for any and all pets being temporarily fostered by Midland County Pit Stop.
PET PROFILE
Pet's Name
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Gender
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Weight
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Breed
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Age
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Spayed/Neutered?
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Microchipped?
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If so, Microchip Number
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Housebroken
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Yes
No
Crate Trained
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Yes
No
Socialized Regularly
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Yes
No
Health Concerns
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Feeding Instructions/Food/Allergies
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Medications
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Favorite toy, game or treat
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Has your pet ever been aggressive or bit anyone?
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Yes
No
If yes, please explain
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When left alone, does your pet bark/cry?
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Yes
No
Is your pet afraid of being left alone?
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Yes
No
Chew?
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Yes
No
Is your pet afraid of strangers?
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Yes
No
Scratch at things?
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Yes
No
Is your pet afraid of loud noises?
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Yes
No
Is your pet afraid of car rides?
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Yes
No
Is your pet afraid of the vet?
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Yes
No
Does your pet do well with children?
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Yes
No
Does your pet do well with dogs?
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Yes
No
Does your pet do well with cats?
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Yes
No
Does your pet walk respectfully at your side on a leash?
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Yes
No
If no, what sets him/her off?
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Has this pet every been cared for outside your home by a sitter, kennel or dog walker?
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Yes
No
If so, please indicate name and contact number
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What commands does your pet know?
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Please indicate any other behavioral issues
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I, (TYPE NAME BELOW) release temporary care of my pet(s), listed above, to Midland County Pit Stop in Midland, Michigan
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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****
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Date
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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******
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Date
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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****
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Date
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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****
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Date
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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***********
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Date
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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****
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Date
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Owner Signature
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Date
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Owner's Printed Name
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Co-Owner Signature
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Date
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Co-Owner's Printed Name
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Midland County Pit Stop Representative Signature
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Date
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Midland County Pit Stop Representative's Printed Name
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Submit
Home
About
Adopt Me!
K-9
Feline
Forms
I Want to Adopt
I Want to Foster
Find a Foster for My Pet
I Want to Help!
Surrender My Pet
Donate
CommUnity
Contact
K9 Katwalk 2023