Date *
First Name *
Last Name *
Street *
City *
State *
Zip code *
Age *
Date of Birth *
Driver's License and State
Cell phone *
Home Phone
Email Address
Preferred type of contact: *
Select one
Cell
Home
Email
All of the above
What types of animals are you interested in fostering (check all that apply) *
Select all that apply
Dog
Cat
Litters of kittens/puppies
Pregnant cat/dog
What type of care can you provide? (check all that apply) *
Select all that apply
Assessment and training period for a dog
Bottle Feeding Newborn Animals (round the clock care)
Hospice/Retirement Care
Recovery From Illness or Surgery
Please share your past experience with any of the above mentioned populations *
Does your home have? *
Select all that apply
Fenced yard
Someone home during the day for house training/to Give medications or feedings
Back up caregiver when you are not at home
Separate room (animals will need to be isolated at First and babies will always need a separate space)
Keep cats indoors only *
No Yes
Maintain supervision of dogs while outside *
No Yes
Give injectable treatments (i.e. insulin, sub-q fluids) *
Give injectable treatments (i.e. insulin, sub-q fluids)
No Yes
Give medications *
No Yes
Syringe feed *
No Yes
Maintain a special diet *
No Yes
Assist with socializing animals (handling kittens, introducing dogs in a safe environment, etc) *
No Yes
House train or maintain a housetraining schedule *
No Yes
Crate train a dog *
No Yes
Participate in obedience training (going to classes, meeting with a trainer, etc) *
No Yes
Attend vet appointments and participate in medical care? Note: MHS covers costs of vet appointments when families use a MHS approved vet or have prior permission but foster parents are expected to participate in the medical care and vet appointments. *
MHS covers costs of vet appointments when families use a MHS approved vet or have prior permission but foster parents are expected to participate in the medical care and vet appointments.
No Yes
Maintain documentation of animal health, weight, behavior, etc? *
No Yes
Allow MHS representative to conduct a home visit *
No Yes
Participate in MHS training *
No Yes
Reference #1 Name *
Reference #1 Phone Number *
Relationship #1 to Applicant *
Reference #2 Name *
Reference #2 Phone number *
Relationship to Applicant *
Vet Name *
Vet Phone Number *
What type of home do you have *
Select One
Own home
Rent (home/condo/apartment)
Other
If you rent, name and phone number of your landlord. Note: If you rent, MHS requires landlord permission before fostering.
If you rent, MHS requires landlord permission before fostering
Members of your Household - include name, age, relationship, and whether they are in agreement to foster *
Pet/Foster name
Species/Breed
Age
Spay/neutered
Up to date on vaccines
Temperament with other animals
How many hours will the foster animal be left alone per day *
If you are interested in fostering a dog, where will the dog be kept?
Why do you desire to foster a shelter animal? *
I understand that MHS will not be responsible for any expenses or damages incurred to your home or people, property or animals which come in contact with the foster animal. *
I understand that MHS will not be responsible for any expenses or damages incurred to your home or people, property or animals which come in contact with the foster animal.
No Yes
I understand that MHS will provide any medical/behavioral history known but illnesses and behaviors previously unknown may present themselves at any time. Foster animals may have or contract illnesses that are contagious to other pets or members of your household. Animals, particularly pregnant/nursing mothers and kittens/puppies may be unvaccinated. As a foster parent you accept this risk and responsibility and will comply with any recommendations by MHS, veterinary or behavioral staff. *
I understand that MHS will provide any medical/behavioral history known but illnesses and behaviors previously unknown may present themselves at any time. Foster animals may have or contract illnesses that are contagious to other pets or members of your household. Animals, particularly pregnant/nursing mothers and kittens/puppies may be unvaccinated. As a foster parent you accept this risk and responsibility and will comply with any recommendations by MHS, veterinary or behavioral staff.
No Yes
I understand that foster parents are responsible for the health and safety of the animal(s) while in the foster home. As a foster parent, the animal in your care may need medical care, medication and/or participation in a behavioral assessment or training program. Foster parents agree to fully comply with all medical and behavioral recommendations. Foster parents understand that recommendations may include taking an animal to medical appointments, following a treatment plan and working with a trainer via home or office visits. *
I understand that foster parents are responsible for the health and safety of the animal(s) while in the foster home. As a foster parent, the animal in your care may need medical care, medication and/or participation in a behavioral assessment or training program. Foster parents agree to fully comply with all medical and behavioral recommendations. Foster parents understand that recommendations may include taking an animal to medical appointments, following a treatment plan and working with a trainer via home or office visits.
No Yes
I understand: MHS will cover medical expenses at MHS approved vets and in pre-approved emergent situations. If you choose to take the animal to your own vet or without first consulting MHS, the foster parent is responsible for the cost. *
I understand:
MHS will cover medical expenses at MHS approved vets and in pre-approved emergent situations. If you choose to take the animal to your own vet or without first consulting MHS, the foster parent is responsible for the cost.
No Yes
I understand: With pre-approval, MHS will reimburse foster families for expenses. Receipts need to be turned in within 30 days of the foster placement ending to be eligible for reimbursement. *
I understand:
With pre-approval, MHS will reimburse foster families for expenses. Receipts need to be turned in within 30 days of the foster placement ending to be eligible for reimbursement.
No Yes
I understand: MHS will not cover veterinary expenses due to foster parent negligence. *
I understand:
MHS will not cover veterinary expenses due to foster parent negligence.
No Yes
I understand: Foster parents will remain in weekly contact with MHS. *
I understand:
Foster parents will remain in weekly contact with MHS.
No Yes
I understand: Foster parents will inform MHS immediately if any of the following occur: not eating, lethargy, upper respiratory symptoms(sneezing, eye/nose discharge, drooling, wheezing), change in bowel habits (diarrhea, constipation), injury or any appearance of being 'unwell' and will follow MHS and veterinary instruction. *
I understand:
Foster parents will inform MHS immediately if any of the following occur: not eating, lethargy, upper respiratory symptoms(sneezing, eye/nose discharge, drooling, wheezing), change in bowel habits (diarrhea, constipation), injury or any appearance of being 'unwell' and will follow MHS and veterinary instruction.
No Yes
I understand: Foster cats must be kept indoors at all times. Foster dogs will be supervised when outside at all times, on a leash or a fenced in area. *
I understand:
Foster cats must be kept indoors at all times. Foster dogs will be supervised when outside at all times, on a leash or a fenced in area.
No Yes
I understand: MHS encourages families to 'advertise' available animals with friends, family and social media networks. However, any adopter will need to apply and be approved by MHS and pay MHS adoption fees before an adoption can occur, even if well known to the foster family. *
I understand:
MHS encourages families to 'advertise' available animals with friends, family and social media networks. However, any adopter will need to apply and be approved by MHS and pay MHS adoption fees before an adoption can occur, even if well known to the foster family.
No Yes
I understand: If a foster parent decides to adopt a foster animal, the foster parent will be required to sign an adoption contract. The foster parent assumes full responsibility for ongoing veterinary (routine, emergency and for pre-existing conditions) care starting on the date of the adoption. *
I understand:
If a foster parent decides to adopt a foster animal, the foster parent will be required to sign an adoption contract. The foster parent assumes full responsibility for ongoing veterinary (routine, emergency and for pre-existing conditions) care starting on the date of the adoption.
No Yes
I understand: If MHS feels the animal is ready for adoption and the foster parent does not wish to adopt, the foster parent will fully participate with the adoption process, including but not limited to bringing the animal to the shelter for interactions, providing any behavioral/medical information to MHS to support the adoptive placement, and/or returning the foster animal full time to the MHS facility. *
I understand:
If MHS feels the animal is ready for adoption and the foster parent does not wish to adopt, the foster parent will fully participate with the adoption process, including but not limited to bringing the animal to the shelter for interactions, providing any behavioral/medical information to MHS to support the adoptive placement, and/or returning the foster animal full time to the MHS facility.
No Yes
By Signing the Foster Care Application and Contract, you agree to the above items *
Clear
Date *
