Foster Parent Volunteer Application & Waiver

Full Name *

First Name Last Name

Cell Phone *

Area Code Phone Number

Emergency Contact Name *

First Name Last Name

Emergency Contact Phone *

Area Code Phone Number

E-mail *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Date of Birth *

Date

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? *

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

Who is your Veterinarian or Vet Clinic? *

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

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

Yes No

Are you a current HSMSC volunteer or foster parent? *

What is your dog walker color level? *

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

What is your level of dog experience? *

Never owned a dog Owned a dog, but have not completed obedience training Have completed basic obedience training with a dog Have completed intermediate obedience training with a dog

What types of activities do you look forward to doing with your foster dog? *

Hanging out at home Cuddling and watching TV Trip to your House Hikes/Local Parks Coffee/Shopping

Do you have a fenced in yard? *

Yes No

What does your home environment consist of? *

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

Is there a particular dog or cat you are interested in or would you like to take the animal with the highest need? *

Fostering Preferences: *

Adult Dog Adult Cat Kitten Puppy

Will you foster a previously abused animal? *

Yes No

Will you foster a puppy or kitten that needs to be bottle fed? Please note bottle feeding occurs every 3-4 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 No bottle feeding experience.

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 Overnight bag Harness I have it all!

Any additional information we should know?

Would you like to receive information on Friends of the Humane Society? For $12/month, you can help save animal lives and receive a free t-shirt! *

Yes No

Foster Program Rules:

All participants must be current dog walking volunteers or have a current foster parent application on file.
Dogs and cats for the program are preapproved and chosen in advance.
We cannot guarantee any dog or cat to anyone, but we will do our best to match you and your family to the best fit for your home.
Dogs are matched up based on volunteer's application, home, and the dog’s level/needs.
Dogs must always stay on a leash, unless in the participant’s home or fully fenced, secure backyard.
Dog interactions with other dogs are not allowed (unless a previous meet & greet was done with staff at HSMSC prior to your foster dog going home).
Foster parents must always keep their foster dog under their supervision, unless inside their home.
You may not leave your foster dog unattended or unsupervised in your backyard.
Please only feed your foster dog or cat the food provided and treats specifically for dogs or cats.
No dog park visits are allowed.
Foster animals must be picked up/dropped off at agreed upon times.

Do you agree to abide by the Foster Program Rules? *

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. *

Initial

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. *

Initial

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. *

Initial

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. *

Initial

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. *

Initial

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: *

Initial

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): *

Initial

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. *

Initial

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. *

Initial

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 21 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 Volunteer Information

THE HUMANE SOCIETY OF MEMPHIS SHELBY COUNTY’S FOSTER PROGRAM