Volunteer Name* First Last Phone*Email* Today's Date* MM slash DD slash YYYY Foster Animal Name(s)*For which CHS location are you fostering?* Newington, 701 Russell Road Waterford, 169 Old Colchester Road (Quaker Hill) Westport, 455 Post Road East What type of pet(s) are you fostering?* Canine(s) Feline(s) Small animal(s)-(rabbit, Guinea pig, etc.) Is your foster pet eating and drinking normally?* Yes No Since your last checkup, has/have your foster animal(s) experienced any of the following? Check all that apply.* Vomiting Diarrhea Blood in stool Constipation Sneezing Coughing Runny nose Eye discharge Loss of fur Itchiness Rashes Loss of appetite Loss of weight Failure to gain weight Dehydration Lethargy Limping Dirty ears Drinking excessively No medical concerns If you checked any of the boxes above, please elaborate on what symptoms you have noticed.Has/have your foster cat(s) had any of the following behavioral concerns? (Check all that apply)* Stool outside the litter box Urine outside the litter box Destructive behavior Aggression Fearfulness Separation Anxiety No behavior concerns Has/have your foster dog(s) had any of the following behavioral concerns? (Check all that apply)* Stool in the house Urine in the house Destructive behavior Aggression Fearfulness Separation Anxiety No behavior concerns Has/have your foster small animal(s) had any of the following behavioral concerns? (Check all that apply)* Stool outside the litter box Urine outside the litter box Destructive behavior Aggression Fearfulness Separation Anxiety Biting humans Attacking other animals No behavior concerns If you responded to the behavioral question(s) above, please explain your answers.What is the energy level of your foster pet(s)?* High Medium Low
