Foster Care Application

Foster Care Application

Heber Springs Humane Society Shelter
ABOUT YOU
Name

First Name Last Name
Date

Month Day Year
Date
Address

Street Address

Street Address Line 2

City State / Province

Zip Code
Phone Number
Email
Date of Birth

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

Alone Spouse/Partner Parents Children Other Relative Other
List the age of each child living in home full or part time.
Do you live in?

Apartment Single Family Home Duplex Mobile Home Townhouse Condo Farm
Do you have a fenced in yard?

Yes No
How high is the fence?
Do you own or rent?

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

Yes No
Can you drive the animal to vet appointments and shelter appointments?

Yes No
Upload a copy of your drivers licenses.

Cancel of
Have you provided foster care to animals before?

Yes No
If yes, when and what kind of animals?
Do you have any experience caring for any of the following?

Kittens Cats Puppies Dogs Injured or sick animals Kittens or Puppies without mother Behavioral Problems
Please provide details
Do you have any experience giving medication to animals?

Yes No Pills Eye cream Ear medicine Liquid medicine
Your current or previous veterinarian's name and phone number.
Will you be able to bring the pet to adoptions?

Yes No Depends/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, you acknowledge that you will abide by these provisions. 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)

Puppies Puppies with mom Orphaned puppies (bottle fed) Pregnant dogs Dogs Dogs with injuries or illness Dogs with special needs (deaf, blind, etc.) Dogs with behavioral problems Kittens Kittens with mom Orphaned kittens (bottle fed) Pregnant Cats Cats Cats with injuries or illness Cats with special needs (deaf, blind, etc.) Cats with behavioral problems
Additional fostering details: (Check all that apply)

Male Female Male or Female Small Medium Large 1 Animal Only 2 Animals 3 Animals 4 or more Animals
ABOUT YOUR ANIMALS
Your Animals *
Are all vaccinations up-to-date?

Yes No
Do any pets have temperament problems or make it difficult to be a foster parent?

Yes No
Please explain any temperament problems.
Do you have any felony convictions?

Yes No
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

Month Day Year
Should be Empty: