Foster Care Application

Foster Care Application

Heber Springs Humane Society Shelter
ABOUT YOU
Name

First NameLast Name
Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Zip Code
Phone Number
Email
Date of Birth

MonthDayYear
Occupation
Why do you want to be a Foster Parent Volunteer?
Other people who live in your home.

AloneSpouse/PartnerParentsChildrenOther RelativeOther
List the age of each child living in home full or part time.
Do you live in?

ApartmentSingle Family HomeDuplexMobile HomeTownhouseCondoFarm
Do you have a fenced in yard?

YesNo
How high is the fence?
Do you own or rent?

OwnRent
If you rent, do you have permission from your landlord to have an animal?

YesNo
Can you drive the animal to vet appointments and shelter appointments?

YesNo
Upload a copy of your drivers licenses.

Cancelof
Have you provided foster care to animals before?

YesNo
If yes, when and what kind of animals?
Do you have any experience caring for any of the following?

KittensCatsPuppiesDogsInjured or sick animalsKittens or Puppies without motherBehavioral Problems
Please provide details
Do you have any experience giving medication to animals?

YesNoPillsEye creamEar medicineLiquid medicine
Your current or previous veterinarian's name and phone number.
Will you be able to bring the pet to adoptions?

YesNoDepends/Possibly
What period of time are you willing to foster?
As a foster parent you will be required to keep your foster dog(s) on a leash or enclosed within a fence adequate for the animal or in a home at all times. Foster cats must be kept inside at all times. By initialing below, you acknowledge that you will abide by these provisions.
Pet Secured Acknowledgment Initials*
Please describe the general area where your foster pet(s) will be kept.
ABOUT THE PET(S) YOU'D LIKE TO FOSTER
I am interested in fostering: (Check all that apply)

PuppiesPuppies with momOrphaned puppies (bottle fed)Pregnant dogsDogsDogs with injuries or illnessDogs with special needs (deaf, blind, etc.)Dogs with behavioral problemsKittensKittens with momOrphaned kittens (bottle fed)Pregnant CatsCatsCats with injuries or illnessCats with special needs (deaf, blind, etc.)Cats with behavioral problems
Additional fostering details: (Check all that apply)

MaleFemaleMale or FemaleSmallMediumLarge1 Animal Only2 Animals3 Animals4 or more Animals
ABOUT YOUR ANIMALS
Your Animals*
Are all vaccinations up-to-date?

YesNo
Do any pets have temperament problems or make it difficult to be a foster parent?

YesNo
Please explain any temperament problems.
Do you have any felony convictions?

YesNo
If yes, list the year and state.
Personal Reference #1 (Non-Related)
Name and phone number
Personal Reference #2 (Non-Related)
Name and phone number
I understand that if the information provided on this application is found to be false/incorrect I will surrender the pet to HSHS upon demand. I agree to abide by HSHS guidelines and return the pet if I cannot keep it and to notify HSHS immediately if the pet is lost, shows signs of health issue, or dies.

I agree to allow a representative of HSHS to inspect the home environment and yard, and if any violations of the contract are evident, I agree to allow the agent of HSHS to remove the pet from the premises occupied by me, and entry shall not constitute a trespass. I certify that the information provided is true and correct.
Name

Clear
Date

MonthDayYear
Should be Empty:

Foster Care Application

As a foster parent you will be required to keep your foster dog(s) on a leash or enclosed within a fence adequate for the animal or in a home at all times. Foster cats must be kept inside at all times. By initialing below, you acknowledge that you will abide by these provisions.