KHS Volunteer Application

Foster Care Application

Thank you for your interest in Companions Animal Center and your desire to help our animals.
Name*

FirstLast
Your date of birth:*

MonthDayYear
Date
Email Address*
Primary Phone Number*

Area CodePhone Number
Call primary phone numberText primary phone numberEmailOther
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Mailing Address (if different from physical address)

Street Address

Street Address Line 2

CityState

Zip Code
Employer/Occupation:*
ApartmentHouseCondoDuplexOther
OwnRent
If you rent, please provide your landlord's name and phone number. Landlord will be contacted.
Yes
How many adults live in the household?*
18 years and older
How many children live in the household? If none, enter 0.*
Under 18 years of age
YesNo
Do you currently have pets in your home? If yes, please list type of animal, male or female, spay or neutered, age, current on vaccinations, where are they kept (indoors, outdoors, both)?*
Please list your veterinarian and clinic name.*
YesNo
If yes, who did you foster for?*
If no, what type of animal experience have you had that would be helpful in fostering?*
CatsPregnant catNursing catKittensBottle baby kittensSpecial needs/medical cat/kittenDog - smallDog - mediumDog - largePregnant dogNursing dogPuppiesBottle baby puppiesSpecial needs/medical dog/puppiesHospice foster catsHospice foster dogs
Do you have any experience with training/working with dogs with behavioral issues? If yes, please explain.*
YesNo
IndoorsSeparate room indoorsKennel indoorsKennel outdoorsDog runDog shelterFenced yard
Where will you keep foster animals when you are home and when you are not home?*
How many hours a day will your foster animals be without adult care?*
YesNo
Yes
YesNo
Yes
By signing this form below, I acknowledge that all information on this form is true and correct. I understand that although CAC takes reasonable care to screen animals for foster care placement, they make no guarantee relating to the animal's health, behavior, or actions. I understand that I receive foster care animals at my own risk and can reject or return any animals for which CAC has asked me to provide care. I hereby waive, release and forever discharge CAC and its employees, volunteers, agents, board members, or trainers from any and all claims (whether present or future) of my household, or any third paties by reason of activities arising out of the participation in the Foster Care Program.
Signature*

Use your mouse or computer touchpad to sign.
Should be Empty: