Doggy Day Out Program Application

Date*

Date

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

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

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth*

Date

Are you 18 years or older?*

Do you have a valid driver license?*

Do you have any experience with handling pets?*

If yes, please explain:

Do you have your own pets?*

Have you ever been charged with animal abuse or neglect?*

By completing this application I agree to the following:

1) That completing this application does not guarantee that I have been approved to participate in the Doggy Day Out Program.

2) I understand the mission of the Humane Society for Greater Lafayette (HS4GL) and as an HS4GL volunteer, I agree to represent the 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 or can NOT 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 foster 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 that HS4GL has the right to terminate this temporary foster care agreement and relationship at will.

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

8) I understand that if my temporary foster pet becomes ill or injured, I will contact HS4GL immediately.

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

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

11) HS4gl Will provide you with all the essential needs for the temporary foster pet(s). I understand any additional money spent on the foster pet(s) on your behalf will not be reimbursed.

12) You may not take the temporary foster pet(s) out of Tippecanoe County.

13) You may not take the temporary foster pet to any dog pars, in pools, or water of any kind, and around your own pets for the safety of you and the pets.

14) I agree to not bring my temporary foster pet near or around my own or anyone else's pets.

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