About You
Title
for example: Mr., Mrs., Ms
First Name *
Middle Name
Last Name *
Your Age *
Email Address *
Enter at least one phone number *
Home Telephone
Work Telephone
Mobile Telephone
Your residence
Street Address *
City *
State *
Zipcode *
Employment
Work/Occupation *
Employer *
How did you hear about fostering with Pippi's Place? *
About Your Household
Human Household Members
Human Household Member 1 - Name
Human Household Member 1 - Age
How will Human Household Member 1 be involved in care?
Human Household Member 2 - Name
Human Household Member 2 - Age
How will Human Household Member 2 be involved in care?
Human Household Member 3 - Name
Human Household Member 3 - Age
How will Human Household Member 3 be involved in care?
Human Household Member 4 - Name
Human Household Member 4 - Age
How will Human Household Member 4 be involved in care?
Animal Household Members
Animal Household Member 1 - Name
Animal Household Member 1 - Age
Animal Household Member 1 - Breed
Animal Household Member 1 - Sex
Animal Household Member 1 - Date of Rabies Vaccination
Animal Household Member 1 - Spayed/Neutered?
Yes No
Animal Household Member 2 - Name
Animal Household Member 2 - Age
Animal Household Member 2 - Breed
Animal Household Member 2 - Sex
Animal Household Member 2 - Date of Rabies Vaccination
Animal Household Member 2 - Spayed/Neutered
Yes No
Animal Household Member 3 - Name
Animal Household Member 3 - Age
Animal Household Member 3 - Breed
Animal Household Member 3 - Sex
Animal Household Member 3 - Date of Rabies Vaccination
Animal Household Member 3 - Spayed/Neutered?
Yes No
Animal Household Member 4 - Name
Animal Household Member 4 - Age
Animal Household Member 4 - Breed
Animal Household Member 4 - Sex
Animal Household Member 4 - Date of Rabies Vaccination
Animal Household Member 4 - Spayed/Neutered?
Yes No
Vet Clinic Info
Name of Vet Clinic
Vet Clinic Phone Number
Rabies
In order to be approved to foster for
Pippi's Place, all animals in your
home must be vaccinated against rabies.
Please consult your veterinarian
about fostering. They may recommend
additional vaccinations to protect
your pets.
If needed, do you have approval to have a foster pet in your home?
Yes No
Fostering
Describe where you will be keeping the foster animals, including how you will separate them from your own animals, if applicable:
Approximately how long, on an average day, will foster animals be left alone in the home (without people to monitor eating, behavior and elimination)?
Describe your previous experience with animals:
Are you currently or have you previously fostered for any other humane organization? If so, which one? *
My household is able to foster:
Select all that apply
Pregnant cat
Nursing mother cat and litter
Kittens: 0-4 weeks of age
Older kittens: 4-10 weeks of age
Adult cat
Recovering from injury or surgery cat or kitten
On treatment for a cold cat or kitten
On treatment for ringworm cat or kitten
Needing behavioral modification cat or kitten
Pregnant dog
Nursing mother dog and litter
Puppies: 0-4 weeks of age
Older puppies: 4-10 weeks of age
Adult dog
Recovering from injury or surgery dog or puppy
On treatment for a cold dog or puppy
On treatment for ringworm dog or puppy
Needing behavioral modification dog or puppy
How long are you able to have foster animals in your home?
Select One
1-2 weeks
3-4 weeks
5-6 weeks
7-8 weeks
9-10 weeks
As long as necessary
Anything else you would like to share about yourself or your experience?
References
Can you provide us with two personal references?
Name and phone or email
Name and phone or email
Agreement Affirmation
By submitting this application, I affirm that I am 18 years or older and that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions or other misrepresentations made by me on this application may result in corrective actions or my dismissal as a Pippi's Place volunteer. I also understand that I will be required to sign an INFORMED CONSENT AND WAIVER OF LIABILITY agreement before I will be allowed to volunteer at any Pippi's Place events.
Do you accept the above affirmation agreement? *
Yes No