Interested in (check all that apply): *
dog
dog with medical needs
dog with behavioral issues
mother with nursing puppies
puppy
puppy with medical needs
puppy with behavioral issues
cat
kitten
bottle kittens
comfortable with administering meds
How soon are you able to begin fostering? *
How long you can foster? *
CONTACT INFORMATION
First Name *
Last Name *
Address *
Mailing Address
City *
State *
Zip *
Home Phone *
Mobile Phone *
Email *
Employer *
Work Phone *
HOUSEHOLD INFORMATION
Do you *
Own
Rent
Live with friends, parent, relative or guardian
Landlord 's Name
Landlord's Telephone
How long have you lived here *
Do you live in a *
House
Apartment
Duplex
Condo
Mobile
Do you have a yard? *
No Yes
Do you anticipate moving in the next 6 months? * *
No Yes
Do you live with *
Friends
Parents
NA
Ages of children under 18, if any *
Are they used to animals? *
No Yes
Do all household members know you are fostering a pet? *
No Yes
Will everyone in the household share in the responsibility of caring for this animal? *
No Yes
Have you or anyone in your family ever been charged or convicted of animal abuse or neglect? *
No Yes
many hours (on average) per day will your foster be left alone? *
Where will your foster be kept while you are not at home? *
Where will your foster be kept a night? *
For Dog Fosters
Do you plan to crate train?
No Yes
How many hours per day will your foster dog be outside/walked/exercised?
If this dog is an adult and needs ongoing training, will you partake in any training sessions that HSW arranges and pays for?
No Yes
Do you agree to only use the collar/harness/leash method HSW provides?
No Yes
Do you agree NOT to take your foster dog to any dog parks, doggie daycare, boarding/pet hotel without prior approval from HSW?
No Yes
FOSTER & PET HISTORY
Do you have any previous foster experience? *
No Yes
What size dog(s) have you had experience with?
< 20 lbs
21 – 50 lbs
> 51 lbs
N/A
What pet(s), if any, have you had in the past? *
CURRENT PETS
How Many Current Pets Do You have *
Please provide the Name, Species, Gender, Age, Spayed/Neutered Status, How long the pet has been with you and Vaccination status for all animals *
How will these pets adjust to a foster pet and how do you plan to acclimate them? *
Veterinarian Name *
Office Name *
Veterinarian Phone *
Time using this vet *
PERSONAL REFERENCES
Name *
Phone *
Name *
Phone *
*
I Agree
By checking this box, I certify that I am at least 21 years of age or older and that ALL of the above information is true to the best of my knowledge and that false information will nullify this agreement. I have not been convicted of any charges of cruelty, abuse or neglect to animals and am not engaged in any commercial breeding or sale of dogs. I give permission to the Humane Society of Walden to verify all information and check references. I also understand that if I am approved to foster I must agree to the terms outlined in the HSW Dog Foster Handbook. I understand that although the Humane Society of Walden takes reasonable care to screen animals for foster placement and will provide 100% full disclosure about any dog I elect to foster, they make no guarantees relating to the animal’s health, behavior, or actions. I understand that I receive foster care animals ay my own risk and can decline to accept any animal for which the Humane Society of Walden has asked me to provide care.
I acknowledge that the Humane Society of Walden is not responsible for any property damage or personal injury suffered by me, members of my household, including my own animals, or any third parties during a foster placement, and I assume liability to provide adequate controls to prevent such damage or injury. I volunteer to accept the rescued animal in my charge as a humanitarian act and agree to release and hold harmless the Humane Society of Walden along with volunteers and Board Members, from any and all liability or responsibility in connection with any pet(s) I agree to foster.
