S-PCHS FOSTER APPLICATION
NAME:
First Name
Last Name
EMAIL
example@example.com
ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
HOME PHONE:
Format: (000) 000-0000.
CELL PHONE:
Format: (000) 000-0000.
HOUSEHOLD / FAMILY INFORMATION
Is everyone in the household in favor of fostering a pet
Yes
No
Anyone in your household have allergies' to animals:
Yes
No
Household size: Adults
Children
Names of adults:
First Name
Last Name
Ages of everyone in your household
ABOUT YOUR HOME
Home type:
House
Apartment
Condo
Mobile Home
Do you:
Own
Rent
If you rent, are you permitted to have pets
Yes
No
Landlord name & phone number:
PERSONAL REFERENCES: (Non-relative that does not live with you)
Name:
First Name
Last Name
Name:
First Name
Last Name
Phone:
Format: (000) 000-0000.
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Email:
example@example.com
Relationship:
Relationship:
CURRENT PET(S) HISTORY
Do you have pets now:
Yes
No
Name:
Breed:
Age:
Gender:
Name:
Breed:
Age:
Gender:
Name:
Breed:
Age:
Gender:
Are current pets spayed / neutered:
Yes
No
Are pets current on vaccinations:
Yes
No
Are pets on preventatives:
Yes
No
If on preventative, what brand(s)
Does your current Pet(s) live:
Indoors
Outdoors
Both
Veterinary office name:
Phone Number:
Format: (000) 000-0000.
Name of person vet records are under:
First Name
Last Name
If current pet(s) live outdoors, or both, please describe/explain:
PREVIOUS PET(S) HISTORY
Previous pet(s) name:
Veterinary office name:
Phone Number:
Format: (000) 000-0000.
Reason you no longer have the pet:
Previous pet(s) name:
Veterinary office name:
Phone Number:
Format: (000) 000-0000.
Reason you no longer have the pet:
Name of person vet records are under:
First Name
Last Name
Back
Next
ABOUT THE PET YOU'D LIKE TO FOSTER
Type of animal(s) you are interested in fostering
Adult Cat
Mom & Kittens
Kittens
Adult Dog
Mom & Puppies
Puppies
Have you ever fostered:
Do you have a fenced yard:
If YES, what kind & how tall:
Foster pets in your care are to be kept inside at all times unless supervised outside on a leash or supervised in an appropriate fenced area. Do you understand and agree to this
Yes
No
Are you aware placement in your home will only be temporary, & that you will be expected to eventually give up the pet for adoption
Yes
No
Do you have access to reliable transportation
Yes
No
Are you willing to take a foster pet to veterinary appointments
Yes
No
Are you willing to keep records for each foster pet and provide uptodate photos to be put on adoption sites
Yes
No
Do you have any experience in providing special needs care, bottle feeding, medication, checking temperature, changing bandages, etc.:
Would you object to a follow-up visit by the Humane Society:
Yes
No
Want to be added to our email list for SPCHS events:
Yes
No
PHOTO RELEASE
During my volunteer time with SPCHS I understand that my photo may be taken at various events and activities. By signing below, I also herby grant the SPCHS permission to use my likeness in photograph(s) and/or video(s) in any and all of its publication, on its website, or in media releases, whether now know or hereafter existing. I will make no monetary or other claim against SPCHS for the use of the photograph(s) and or video(s).
Name:
First Name
Last Name
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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