Foster Home Application

Date

Name*

Physical Address*

Address

Street Address Line 2

CityStateZip

Home phone

Cell phone*

Work phone

May we contact you at work ?

YesNo

Email*

example@example.com

Do you own or rent your home ?

OwnRent

If renting, Landlord name

Landlord phone#

Please be sure to answer all questions, which will assist us in processing your application. We will contact you once your application has been approved to set up a foster home visit. Any misrepresentation of true facts in this foster home application will invalidate your opportunity to foster.

I am interested in fostering (select all that apply)*

	Cats	Dogs	Small Animals
Mothers w/babies (8 week commitment)
Senior/Hospice
Special needs
Bottle kittens (8wk commitment, feeding every 2-3hrs for min 2wks)
Under socialized kittens (prior experience with difficult cats recommended)
Weekend/holiday/day trips for dogs
Pregnancy watch (rabbits & guinea pigs)

List all people in your home and their ages, starting with yourself*

	Name	Relationship	Age
Foster Applicant
Person 2
Person 3
Person 4
Person 5
Person 6

Lisa all current animals in your home*

	Name	Species/Breed	Age	Sex	Spayed/Neutered?
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5
Pet 6

Name of Vet Clinic*

Phone*

Have you informed your veterinarian we may be contacting them ?*

YesNo

How long will your foster animals be left alone during the day ?*

Are you able to give medications as prescribed by our veterinarians?*

Yes - I have experience medicating animalsYes - able to do, have no experienceNo - I'm not comfortable giving medications

Please indicate your agreement to the Foster terms and requirements by initialing each statement:

I agree to let a PMSPCA staff member inspect my house as a foster residence in accordance with RSA Agr 1704.10*

I agree to care for and house my foster animal up to adoption time (average foster period 1-3 months).*

I understand that PMSPCA cannot guarantee the health of the foster animal placed in my care.*

I agree to make all necessary transportation arrangements for my foster animals.*

I agree to maintain communication with the Volunteer Coordinator and respond to correspondence within 48 hours.*

I agree to serve as an adoption advocate for my foster animal(s) and support the policies and procedures of the PMSPCA.*

I agree to provide enrichment for my foster animal as directed by PMSPCA staff (re: walks, wand toys, feeding puzzles etc.)*

I agree to house my foster animal indoors in my primary living space (no garage, porches or other outside living spaces).*

When outside, I agree to have my foster dog on leash and under my control at all times. If I have a fenced in yard, I will make sure it is secure and the animal will be supervised.*

I certify that all statements and information on this Foster Home application are true. I understand that any misrepresentation of true facts in this Foster Home application will invalidate my opportunity to foster animals.

Signature*