PVCHS Foster Application

Today's Date *
First Name *
Last Name *
Street Address *
City *
State *	IN IL AL AK AZ AR CA CO CT DE FL GA HI ID IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip Code *
What is your home phone number?
What is your work phone number?
What is your cell phone number?
Our fosters will be alerted about available animals via email. What is your email address? *
How many adults reside in your home? How many children?
What are you interested in fostering? *	cats dogs other
Please select the following types of animals you are interested in fostering: *	Pregnant/nursing mother with their puppies/kittens Puppies/ kittens that require bottle feeding Puppies/ kittens too young for adoption Animals with medical needs Hospice animals Animals with behavior concerns other
Are you comfortable administering medication? *	- Yes, I have administered medication to animals before Yes, but I will need a demonstration on how to administer the medication No
Do you have an area separate from your owned pets to prevent injury or the spread of illness? *	- Yes No N/A
If interested in fostering dogs, do you have a yard? *	- Yes No I am not interested in fostering dogs.
If you do not have a yard, are you comfortable walking the dog several times daily on leash?	NoYes
Do you have reliable transportation to bring the animal to the shelter when needed? *	NoYes
Have you fostered previously? *	NoYes
If you have fostered previously, list the organization(s) you have been involved with.
If you have fostered previously, describe your foster experiences.
What is your valid driver's license number? *
Have you ever been convicted or investigated for animal cruelty? *	NoYes
Please sign your name to finish this application after you verify all above information is correct. *	Clear