Chippewa Humane Foster Application

In order to be considered to be a foster home for CHA pets, you must:

You must be 21 years of age
Have the knowledge and consent of all adults in the household
Have verifiable identification
Understand that CHA has the right to deny your application

Before fostering a pet from our shelter, you must fill out a foster application, understand and agree with the foster program's goals; meet the CHA adoption standards; prove that pets you own are sterilized, vaccinated, and well cared for. We also request that all foster homes be open to a home inspection and display they can provide for the foster pet during the time of their stay.

I am interested in providing foster care for (check all that apply):

Bottle fed kittens Kittens too young for adoption Nursing mom with kittens Pregnant cat Injured/Post Op cat Adult cat FIV+ Cats

Name

First Name Last Name

Date of Birth

Date

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Do you live in a:

House Apartment Mobile Home Duplex

Do you:

Rent Own

If you rent, please list the landlord's name and phone number:

Primary Phone

Area Code Phone Number

Secondary Phone

Area Code Phone Number

Email *

This will be used to communicate while your application is being processed, so please use an email that you check frequently!

Preferred Method of Contact

Describe the area where you will be keeping your foster:

Do you have pets of your own?

Yes No

Please describe the current animals in your household (Species, Name, Sex, Age, Kept Where)

Are your animal(s) up to date on vaccinations?

Yes No

Are your animal(s) spayed/neutered?

Yes No

Veterinary Name

Veterinary Phone Number

Area Code Phone Number

Why would you like to join our foster program?

Please Read Carefully and Sign: The undersigned applicant hereby grants the Chippewa Humane Association permission to confirm any information provided in this application with any appropriate third party source, including landlords, veterinarians, etc. The information obtained will be held in confidence and used only by the Chippewa Humane Association for purposes of this foster application. I certify that all the information on this application is true and complete. I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected. I also understand that this foster application is at its own discretion. It is specifically understood that the Chippewa Humane Association reserves the right to deny any foster application at its own discretion.

Signature

Clear

Foster Waiver and Agreement:

This agreement is entered into the Chippewa Humane Association (CHA) jointly by the undersigned, “Foster” in order to permit the foster to participate in the Foster program at CHA. This agreement is for the benefit of CHA and each of its staff members, employees, officers, directors, and representatives. I affirm that I have been advised that the activity of working with the shelter animals is hazardous and involves contact with animals that are unpredictable. As such, CHA cannot be held liable for injuries or accidents that may occur as a result of working with these animals.

I am aware that injuries, loss of or damage to personal property, or death may occur as a result of my participation on CHA property or with off-site volunteer activities such as, Adoption outreach, Foster Care, Special Events, etc.

I agree CHA and the released parties shall not be held responsible or liable for any personal injury, other injury, death, damage, loss, or expense, either to myself or my personal property, whether or not such negligence of CHA, and released party or any other person. It is my intention to exempt and hold harmless CHA and all released parties from any and all liability related in any way to my participation as a Foster.

I understand and agree that if any provision of this agreement is found to be unenforceable in any way, it shall be enforced to the maximum extent possible and all other provisions of this agreement shall remain in full force and effect.

I represent and warrant that I have the authority to enter into this agreement.

I understand that, if my foster application is accepted, I will be serving CHA in a foster capacity and I have no expectation of payment or compensation for my service.

I will treat animals, people and property that I come in contact with at the CHA with respect.

I will refrain from using profanity and will conduct myself with courtesy at all times.

I agree to commit to a foster minimum of one time in a six month period. If this commitment is not met, then I understand I will be placed on Inactive status.

I understand that as a foster, I may gain access to information about CHA, its clients, donors and/or staff members which are confidential in nature. I agree to maintain confidentiality and will never disclose any information that is either private or personal.

I understand that fostering for the CHA is a privilege and that my active foster status at CHA may be discontinued any time, for any reason.

I hereby acknowledge that I have read, understand and agree to all of the guidelines and agreements discussed above.

Signature

Clear