Foster Sign-Up

I acknowledge that the Jefferson County Humane Society is located in Wintersville, OH: *

This application is for fostering only. If you wish to adopt please call the shelter at (740) 314-5583 or stop in during regular business hours. Adoptions are done on a first come/first served basis unless the animal is posted with a link to an adoption application to be completed due to special needs. *

I'm aware that the purpose of this application is to apply to become a foster caregiver and is not to be used for the purpose of applying to adopt an animal.

Do you have reliable transportation? *

First Name: *

Last Name: *

Date of Birth: *

Street Address: *

City: *

State: *

Zip Code: *

How long have you lived at this address? *

Home Phone: *

Cell Phone: *

Work Phone:

Email Address: *

Confirm email

Do you own or rent? *

Own
Rent

Please provide the name and phone # of landlord: *

Will you provide written permission from the landlord to have pets? *

Type of home: *

House
Apartment
Mobile Home
Other

Are there any neighborhood homeowner restrictions that need to be considered and if so what? *

Occupation: *

Employer:

Work days and hours:

Do you have a fenced yard? *

Type/Height of Fence: *

How would you describe your household? *

Active
Quiet
Other

Name(s) of other adults in household: *

Do you have any children living in your home? *

Please list their names and ages: *

Do you have any children visiting your home on a regular basis? *

Please list their names and ages: *

Do any members of your household have allergies? *

Do you have a room in your home where the foster animal can be kept isolated from family pets? *

Please describe the location: *

Are all household members in agreement with bringing home a foster animal? *

How long are you willing to foster for? *

Where will the foster animal spend most of its time? *

Are you willing to allow a JCHS representative to do a home check? *

Which pets are you willing to foster? Please select all that apply: *

What size dogs can you foster? Select all that apply: *

How many hours per day will your foster animal be left alone? *

Where will your foster animal stay during the day? *

Where will your foster animal stay at night? *

Have you had any pets in the past? *

How long did you have the pet? *

Please list all veterinarians used in the last 5 years (Name, Address & Phone #): *

Do you have any pets now? *

Please list name, age, gender, species and whether spayed/neutered for EACH animal currently in the home: *

Are your pets spayed or neutered? *

Yes
No

Are your pets current on their vaccinations? *

Yes
No

Is there anything else you would like us to know?

We currently use a Facebook group to post animals needing foster, updates, etc. Do you use Facebook? *

If you don't use Facebook, what are the best ways for us to try to keep you up to date about foster needs, etc.? SELECT ALL THAT APPLY: *

Reference #1 - name, phone # & relationship to you: *

Reference #2 - name, phone # & relationship to you:

JCHS CANNOT GUARANTEE THE HEALTH, TEMPERAMENT, OR TRAINING OF THE ANIMAL. JCHS DOES NOT KNOW THE COMPLETE HISTORY OF THIS ANIMAL AND THUS OFFERS NO WARRANTY OR REPRESENTATION OF ANY KIND REGARDING THE HEALTH, DISPOSITION, OR SUITABILITY AS A DOMESTIC PET. FURTHER, THE FOSTER AGREES TO RELEASE JCHS OF ANY LIABILITY FOR ANY HAZARD OR DAMAGE IT MAY PRESENT TO ADULTS, CHILDREN, OTHER ANIMALS, OR PROPERTY ONCE THE DOG IS IN HIS/HER POSSESSION.

I understand a JCHS representative may visit my home for a home inspection before my foster application is approved. I understand that if I am approved for fostering I will also need to carefully read the “Foster Care Agreement” which is a separate document from this “Foster Care Application”. The Foster Care Agreement represents the legal contract between a foster caregiver and The Jefferson County Humane Society and Jefferson County Animal Shelter. I understand that if I am approved to foster an animal, I must review the Foster Care Agreement, agree to the terms of the Agreement, and sign the Agreement before I can take my foster animal home.

I have read this Application in its entirety, and I certify the answers to this questionnaire to be true and that any false information may result in nullifying the foster agreement. I make this statement under penalty of perjury under the laws of the state of Ohio.

By signing your name you are asserting that all information provided in this application is true and correct: *

Today's Date: *

Upon submitting your Foster Application you will be redirected to our Online Orientation Video and Questionnaire. You must watch the Orientation Video and complete the short quiz in order to become an approved JCHS Foster Care Volunteer. Thank you!