Foster Parent Application

Date*

Date

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth:*

Date

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email*

example@example.com

Do you:*

OwnRent

If you rent, does your agreement allow animals"

YesNo

How many adults are in your household?*

How many children?*

Ages of children:

Do you currently have pets?*

If yes, how many?

Please list type of pet, age, sex, and spayed/neutered status.

Are your pets at home up-to-date on their vaccinations?

If not, what vaccinations are they without?

Do your pets get along with:

DogsPuppiesCatsKittens

Do you have previous foster experience?*

Who are you interested in fostering? (Mark all that apply)*

Do you feel comfortable giving medications (pills or liquid)?*

Length of time during the day your animal would be left alone:*

Where will you keep your pet while you are away?*

Where will you keep your pet at night?*

If you foster a dog, do you have a fenced in yard?

How did you hear about our Foster Program?*

By completing and signing this application I agree to the following:

1) That completing this application does not guarantee that I have been approved for fostering.

2) I understand the mission of the Humane Society for Greater Lafayette (HS4GL) and as a HS4GL foster volunteer, I agree to represent this mission within the community on behalf of the organization.

3) I understand that by taking a foster animal into my home that HS4GL is not responsible and CANNOT be held accountable for incidents and accidents in the house or any other home or place of business.

4) I understand that HS4GL is the sole guardian of the animal(s) taken in foster care and that fostered pet(s) must be returned to HS4GL upon HS4GL's request.

5) I understand that only HS4GL's Foster Coordinator, Veterinarian, and Executive Director, have the authority to make changes to the program guidelines.

6) I understand HS4GL has the right to terminate this foster care agreement and relationship at will.

7) I understand that I MUST contact the Foster Coordinator immediately if my foster pet(s) bites and breaks skin.

8) I understand that if my foster pet becomes ill or injured, I will contact HS4GL immediately. Most medical issues will be treated at the shelter by HS4GL's veterinarian. In the event of a TRUE emergency after hours, I will contact the foster coordinator AND Purdue Smal Animal Emergency.

9) I understand that if I, as a foster volunteer, want to adopt any of my foster pet(s), I must go through the standard HS4GL adoption process. I also understand that I cannot send my foster pet(s) to an adoptive or potential adoptive home without the permission of HS4GL.

10) I agree that as a foster care provider, HS4GL shall be held harmless from any and all claims, liability, judgements, losses, damages, expenses, or costs of any kind arising out of injury related to the HS4GL foster care program.

11) HS4GL will provide you with all the essential needs for the foster pet(s). I understand and additional money spent on the foster pet(s) on your behalf will not be reimbursed.

12) You may not take the foster pet(s) out of Tippecanoe County. If traveling with your foster pet(s), please contact the foster coordinator for permission to do so.

I certify that the information entered on this application is true and I have read and understand the above agreements.*