Animal Foster Application Form

Please remember to hit "SUBMIT" at the end or your information will not be saved and sent to us. Contact us at askus@nemohumane.com with any questions regarding this form. Thank you!

Full Name*

First NameLast Name

E-mail*

Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Phone Number *

Area CodePhone Number

Does Anyone in your Household have Allergies to Animals?*

YesNo

Are all members of your Family agreeable to Fostering a Dog?*

YesNo

Are you willing to foster a pet of any age?*

YesNo

If not, what age would you consider?

What type of pet would you like to foster? (Check all that apply)*

DogCat

Are you willing to take your foster pet to vet appointments at a convenient time for you?*

YesNo

Are you willing and able to medicate your foster, even if it just a monthly heartworm preventative?*

YesNo

We cannot guarantee a pet to be housebroken, are you equipped to train with love and patience?*

YesNo

Have you had any experience with with an emotionally or physically neglected or abused pet?*

YesNo

If Yes please explain

Are you willing to use a crate for a pet if recommended?*

YesNo

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully. I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any Mortheast Missouri Humane Society animal fostered by me. I certify that the above information is correct, and I understand that the information will be verified. I understand that by submitting this form electronically, I agree to release and covenant to hold harmlessNortheast Missouri Humane Society and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the foster pet. I accept full responsibility for the pet(s) actions at all times, and release Norhteast Missouri Humane Society from any liabilities or damages that may be incurred because of fostering such dog(s). I agree that if I'm unable to foster the pet(s) anymore that I will return the pet(s) to Northeast Missouri Humane Socoety and try to give Northeast Missouri Humane Society a 2 week period to try and find another suitable foster for the pet(s).

Date*

MonthDayYear

Your name*

Co-Applicant name (if applicable)