Foster Parent Application & Waiver

Full Name *

First Name Last Name

Cell Phone *

Area Code Phone Number

Email *

example@example.com

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Date of Birth *

Date

Emergency Contact Name *

First Name Last Name

Emergency Contact Phone *

Area Code Phone Number

Emergency Contact E-mail *

HSMSC will do our best to work with fosters who wish to adopt their foster pets, however, fosters are required to submit an adoption application for approval by the adoptions department. I acknowledge that this application is to foster pets only and is not considered an adoption application. *

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The following questions are intended to give us some information to ensure that you will have a successful foster experience with HSMSC! Please know that we do not disqualify fosters for renting, living with family, being under 21yrs old, being unemployed or having other pets. But, it is helpful for us to have this information so we can make sure any pet we place with your is a good match, and so we can be clear about our expectations of foster parents.

Are you 21 or over? If not, parent info is required. (Please keep in mind if you wish to adopt your foster animal, our adoption age is 21. Please refer to our adoptions team for more info) *

Yes No

Do you own or rent your home? *

Own Rent

Do you live in a *

If you rent (or lease to own) please list the name and phone # of landlord, President and/or manager of any homeowner, condo or other similar associations, apartment, or park manager: *

Where are you employed?

Do you know if your company has any corporate philanthropic contribution programs such as donation matching or encouraging volunteer hours?

If approved, do you plan to count time spent fostering an animal towards volunteer/community service hours for school, scholarships, clubs/organizations, etc.? (Please discuss program requirements with the foster coordinator)

Yes No Unsure

Do you have a fenced in yard? *

Yes No Fenced on some, but not all sides

Where will your foster pet be kept when you are not home?

Where will your foster pet be kept overnight?

Is anyone in the home allergic to pets of any kind? If yes, please explain.

Are there any children (under 18) in the home? If yes, what are their ages?

What types of pets do you currently have in your household? Name? Dog/Cat? Male/Female? Spayed/Neutered? When were last vaccinations given? How long owned? Inside/Outside? *

Who is your Veterinarian or Vet Clinic? *

Have you ever surrendered an animal to a shelter or animal control facility? *

Yes No

Does HSMSC have your consent to contact your veterinarian? *

Yes No No current pets

Do any animals in your home have any medical problems(FIP, FIV, FeLV, Parvo, etc.)? *

Yes No

Are you a current HSMSC volunteer? *

What is your dog walker color level?

Blue Orange Red Purple / Group Leader Not a dog walking volunteer, yet!

Have you ever fostered a pet in the past? *

Yes No

What is your level of dog experience? *

Never owned a dog Owned a dog before, but not experienced or familiar with training Somewhat experienced with dogs, familiar with basic training Experienced with dogs, understand how to train at intermediate level Veterinary or Animal Care professional

What is your level of cat experience? *

Never owned a cat Owned a cat, know the basics of cat care Veterinary or animal care professional

What does your home environment consist of? *

Dogs Cats Children 1-6 years old Children 7-12 years old Children 13+ None

Our foster program is designed to place young pets, medically needy pets, or pets needing behavior modification in homes where they can receive appropriate care outside of the shelter. Typically we will not place healthy, adoption-ready pets in foster homes. However, we do make exceptions depending on the needs of specific pets in our care. Is there a specific cat or dog that you saw on our available pets page and are interested in meeting for a foster? Please note, small dogs, puppies, kittens, and highly desirable breeds of dogs will not be considered for fosters as they are the most easily adopted.

Fostering Preferences: *

Adult Dog Adult Cat Kitten Puppy

Will you foster a previously abused or neglected animal? *

Yes No

Will you foster a puppy or kitten that needs to be bottle fed? Please note bottle feeding occurs every 2-4 hours, 24 hours a day. *

Yes, I will bottle feed puppies Yes, I will bottle feed Kittens No, I am not interested in bottle feeding

Have you previously bottle fed a puppy or kitten? If so, when?

Yes, a puppy Yes, a kitten

Will you foster an animal with medical problems? *

Yes No

Have you ever fostered an animal before; what kind; for what group? *

Where will the animal be kept when you are not home? *

Do you have any specific needs for your foster dog or cat? *

Crate/Kennel Harness Litter and Litter Box Toys Food dishes I have it all!

Any pet we place in foster will need to have regular vet appointments at our clinic. Generally, these appointments will be scheduled Monday-Thursday between 1-3pm, and Friday-Saturday between 10am-3pm. I acknowledge that as a foster it is my responsibility to bring my foster pet in for these appointments as scheduled, or reach out to the foster coordinator to reschedule as needed. *

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Any additional information we should know?

Foster Program Expectations:

Pet foster parents are expected to bring their pets in for regular check ups at our clinic. Puppies and kittens will require appointments for vaccine boosters every two weeks. Other pets may require more frequent appointments based on medical needs.
Pet fosters will be given a sheet with appointment times and dates when they pick up their pet. When they need to reschedule, fosters will contact the foster coordinator as soon as possible.
Fosters will keep cats in their care indoors at ALL TIMES.
Fosters will not allow puppies or dogs off leash unless they are in their own, fenced-in yard. Dogs and puppies will not be off leash in parks, even dog parks.
Fosters will give any necessary medications to their pets as prescribed by the HSMSC clinic.
Foster placements are at the discretion of HSMSC and can be ended at any time, for any reason, by HSMSC or the foster parent.

Do you understand and acknowledge the Foster Program Expectations? *

Thank you for your interest in HSMSC’s Foster Program. This is a unique program that allows volunteers to take shelter dogs and cats to their homes for short-term fostering. By participating in the Foster Program, I agree to the following:

I understand that volunteering with The Humane Society of Memphis & Shelby county, hereby referred to as HSMSC, may require me to come in contact with animals, and that there are risks associated with my volunteer activities, including but not limited to dog bites and/or scratches. I assume the risks and accept personal liability for any damages that might occur as a result of my volunteer activities. I HEREBY IRREVOCABLY RELEASE HSMSC, AND (2) ITS OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, AND VOLUNTEERS (collectively referred to as “Released Parties”) FROM ANY AND ALL CLAIMS I MAY HAVE, OR WHICH MAY HEREAFTER ACCRUE TO ME, AGAINST RELEASED PARTIES FOR PERSONAL INJURY, INCLUDING DEATH, AND ALL PROPERTY DAMAGE OR LOSS, ARISING OUT OF MY VOLUNTEER ACTIVITY WITH HSMSC. *

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I hereby agree to indemnify, defend and hold the Released Parties harmless from any and all liability, losses, damages,judgments, or expenses, including attorneys’ fees, that the Released Parties may sustain in connection with any third party claims that arise out of my volunteer activities, whether such volunteer activities occur on HSMSC'S premises, at my home, or elsewhere. *

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I UNDERSTAND THAT HSMSC DOES NOT ASSUME ANY RESPONSIBILITY FOR OR OBLIGATION TO PROVIDE FINANCIAL ASSISTANCE OR OTHER ASSISTANCE, INCLUDING BUT NOT LIMITED TO MEDICAL, HEALTH, OR DISABILITY INSURANCE OF ANY NATURE IN THE EVENT OF MY INJURY, ILLNESS, OR DEATH, OR DAMAGE TO OR LOSS OF MY PROPERTY. I UNDERSTAND THAT HSMSC DOES NOT PROVIDE WORKERS COMPENSATION INSURANCE FOR VOLUNTEERS. AND HEREBY EXPRESSLY WAIVER ANY CLAIM FOR COMPENSATION OR LIABILITY ON THE PART OF HSMSC IN THE EVENT OF ANY INJURY OR MEDICAL EXPENSE. *

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I agree that if I volunteer to transport any HSMSC animal(s) in my personal vehicle for any purpose, I will 1) maintain at least the state-required minimum amounts of automobile insurance on the vehicle, and 2) release, indemnify and hold the Released Parties harmless from any claims arising from and/or related in any way to such animal’s presence in my vehicle. *

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I acknowledge and understand that I am a volunteer of HSMSC. I am not eligible for HSMSC’s Workers’ Compensation or any other type of compensation or employee benefit in connection with my volunteer activities. *

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If approved to foster, I:

Acknowledge that this animal(s) belongs to the Humane Society of Memphis& Shelby County, and I will promptly return the animal when requested: *

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Agree to bring the animal to the Humane Society of Memphis& Shelby County for all shots and to have the animal spayed/neutered the week it is due (if applicable): *

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Acknowledge that the behavior of the animal, while in my care, is my responsibility and the Humane Society of Memphis & Shelby County is not liable. *

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Under penalty of law, I certify that my answers are true and complete to the best of my knowledge. I am aware of the common obedience problems with shelter pets and I agree to allow my adopted/fostered pet time to adjust to its new environment. If my living circumstances change and I am unable to provide suitable accommodations for my adopted/fostered pet, I understand that I am to surrender it back to the Humane Society of Memphis & Shelby County. *

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By using the HSMSC tags or the #dogventure #doggydayout #hsmscfoster or #hsmscdv hashtags in the images and other content I post on my social media accounts related to my volunteer activities, I hereby grant HSMSC a non-exclusive, fully paid, worldwide, perpetual license to use, modify, publicly perform, publicly display, and reproduce my photographs, name, and likeness solely for marketing and promotional purposes.

I certify that I am 18 years of age or older. I agree to abide by its requirements and guidelines. Further, I specifically agree to the following:

1. To care for and treat humanely any dog or cat given to me.

2. To keep the dog on leash unless confined in my home or securely fenced yard.

3. To use reasonable care to ensure the safety and well-being of the dog or cat in my care, the safety of other dogs or cats, and the people the dog or cat comes into contact with.

4. To contact HSMSC if the dog or cat exhibits symptoms that indicate a serious condition.

5. To keep the dog under my direct supervision at all times during the volunteer activity.

6. To immediately notify HSMSC in the event of a missing or injured dog or cat, if the dog or cat bites any person or animal, or any other injury or accident that I witness or experience resulting from my volunteer activities.

7. That all dogs and cats are the property of HSMSC and shall not be sold, given away, or adopted out without prior approval of HSMSC’s authorized personnel.

8. To provide any change of my personal information, such as name, address, or phone number.

I understand that this Foster Volunteer Agreement and Release is binding on my heirs, assigns and legal representatives. This Foster Program Volunteer Agreement and Release form is executed by me voluntarily and without reliance upon any representation by any person.

By signing below, I acknowledge and represent that I have read and understood the foregoing release, sign it voluntarily, and agree to the indemnity and waiver of liability above. *

Signature

Date *

Date

HSMSC Foster Parent Information

FOSTER PROGRAM WAIVER AND RELEASE