Foster Parents Application
Complete this application to apply to foster animals with the Chemung County SPCA.
Personal Information
Full Name
*
First Name
Last Name
Address
*
City
*
State
*
Zip Code
*
Date of Birth
*
-
Month
-
Day
Year
Date
Daytime Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Evening Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Housing
Do you own or rent your home?
*
Own your home
Rent your home
If you rent, landlord's name
Landlord's phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Type of residence
*
House
Apartment
Mobile home
Pets & Foster Preferences
Please list any other pets in the home. Please be sure to include type, gender, age, and spay/neuter status.
*
Veterinarian
Veterinarian's phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Please describe the general area where the animals you are fostering will be kept
*
I am willing to foster the following (please check all that apply):
*
Cat with kittens
Sick cat/kittens
Cats
Kittens
Dog with puppies
Sick dog/puppies
Puppies
Dogs
Availability & Experience
Is someone home during the day?
*
Yes
No
If no, how long will the animal(s) be alone?
Have you ever fostered animals before?
*
Yes
No
If yes, for which organization?
Agreements
Are you willing to have someone from the Chemung County SPCA conduct a home visit?
*
Yes
No
Are you willing to have someone from the Chemung County SPCA visit the animal(s) during their stay?
*
Yes
No
Do you have a readily available vehicle to use in case of an emergency?
*
Yes
No
Do you have a working telephone line where you can be reached?
*
Yes
No
Will you abide by all animal control laws with regard to your foster animal(s)?
*
Yes
No
Will you be able to bring the animal(s) back to the SPCA for check-ups or medical care?
*
Yes
No
Will you be able to administer medications if required or needed?
*
Yes
No
References
References
Please provide three personal references who can speak to your character, experience, and suitability for fostering.
Reference #1 Name
*
Reference #1 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference #2 Name
*
Reference #2 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference #3 Name
*
Reference #3 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Agreement & Signature
Agreement
I have read and understand the above statements.
*
By checking this box, I am indicating that I have read, understand and agree to all of the above statements
Signature (please type your full name):
*
First Name
Last Name
Date:
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: