Foster Care Application

Humane Society of the Flint Hills

FOSTER CARE APPLICATION

Must be at least 18 years of age to fill out application

Last Name ___________________________ First Name ______________________

Address _______________________________ City __________ State _______ Zip ______

Home Phone __________________________ Cell Phone _______________________

Email _____________________________________________________

Type of animal(s) you are interested in fostering (please check all that apply):

Dogs ( )  Puppies ( )  Nursing Dog with Puppies ( ) Cats ( )  Kittens ( ) Nursing Cat with Kittens ( )

Other ( )

How did you hear about our program? ______________________________________

Do you live in a Home ( ) Apt ( ) Duplex ( ) (If you rent we will need to verify your landlord's pet policy. Phone number for landlord _________________________

Number of Adults in home? _____ Number of Children? _____ Ages of Children? _____

Have you ever fostered an animal before? __________ If yes, what kind? ___________________

Do you have a separate room to keep a foster animal in at your home? _____________

*Please note, to foster kittens and/or cats you MUST have a separate room in which to keep them.

If fostering a dog, do you have a fenced yard? ______ What type and how high? ______________

Have you or a family member ever been convicted of any animal related misdemeanor or felony offence? ____ If yes, please describe _____________________________________________

How long are you able to foster an animal? ____________________________

Are you willing and capable of giving medications if needed? ___________________________

What hours are you generally home to provide care for your animals? Is someone home during the day? ______________________________________________________________________

Are you able to leave work to tend to them during the day? _____________________

Where are the animals kept in your home? (Day/Night?) ________________________________

_______________________________________________________________________

Describe the location and flooring. ______________________________________________

When would be the best time for our Foster Coordinator to come and observe where the animals will be kept? ____________________ *Home visits are required before approval.

Please list all current animals in your home. (Name/Breed/Age/Sex (Spayed or Neutered)

We will need to verify that all your animals are current on their vaccinations. Please list your veterinarian's name and phone number so we may contact them: _____________________________________________________________________

What are they vaccinated against? _____________________________________________

I certify that the above information is true, and that I have read the information regarding the requirements and responsibilities of being a foster parent and feel capable of performing these duties.

I understand that there may be expenses involved in fostering, and will abide by the guidelines set for by the Humane Society of the Flint Hills for reimbursement of certain expenses. I further understand that there is a danger inherent in handling animals, and that I agree to hold harmless and indemnify the Humane Society of the Flint Hills from any injuries or loss sustained by me or others, which may be caused by the animal9s) I am fostering.

Signature_________________________________________

Date ____________________________________________