Converse Animal Care Facility - Foster Application
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
State of Driver License
Date of Birth
*
-
Month
-
Day
Year
Date
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
Please enter a valid phone number.
Have you met the pet you are interested in fostering?
*
Please Select
Yes
No
Have not chosen one yet.
Type of Housing You Live In
*
Please Select
House
Apartment
Condo
Townhome
Mobile Home
Other
Rent or Own
*
Please Select
Rent
Own
Live with Parents
If you rent, please list name and phone number of landlord
Does Landlord have any age, weight, breed restrictions?
*
Fenced In Yard
*
Please Select
Yes
No
Back
Next
On average, how many hours per day will you foster pet be left alone?
Where will you foster pet stay when you are not home.
*
Please Select
Loose inside
Loose outside
In Crate
In Seperate Room
Other
Do you have the ability to separate personal pets from foster pets for at least 7 days? If no, please understand that you are putting your personal animal at risk of catching communicable disease often found in shelter animals. Contact ACSLiveRelease@conversetx.net with any questions*
*
Please Select
Yes
No
N/A, I dont have pets
Total number of adults in household (over age of 17)
Total number of children under age of 17 years and younger.
Do you have personal pets living at you home?
Yes
No
I understand that the pet I have taken into foster care is under the ownership of the City of Converse TX - Animal are Facility until the pet has been legally adopted and all applicable paperwork and fees have been tendered.
I understand
I understand that the behavior of animals is sometimes unpredictable and some animals are capable of inflicting diseases, serious personal injury, death, or extensive property damage. I understand that my foster activities on behalf of Converse Animal Care Facility may place me in a hazardous situation and could result in injury to myself, family, pets, or personal property. I agree to indemnify, defend and hold Converse Animal Care Facility and its agents, officers, directors, manager, and employees free and harmless from all liability arising out of any and all claims, demands, losses, damages, action, judgments of every kind and description that may occur to or be suffered by me by reason of activities arising out of this agreement.
I understand
I further agree to indemnify, defend, and hold Converse Animal Care Facility, its agents, officers, directors, and employees harmless from and against any and all claims, demands, liablities, causes of action, damages, costs (including reasonable attorneys' fees and disbursments) and judgements made or incurred by or found against them, resulting from or arising out of: (i)any breach or default by me of any term or provision of this agreement; or (ii) any negligent or willful act or omission by me with respect to my services pursuant to this Agreement.*
I understand
I understand that at anytime before pick up, my foster pet can be dispositioned to an or adopter or rescue
I understand
I understand that the animal fostered will be marketed for placement and can be tagged by a rescue while still in you care.
I understand
I understand that Converse Animal Care Facility, without notice or hearing may terminate my foster status at any time, for any reason, with or without cause.*
I understand
Submit
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