Foster Application Personal InformationLegal Name* First Middle Last Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth* MM DD YYYY Email* Primary Phone*Alternate PhoneEmployerWork PhoneWork Schedule Household InformationAre you the owner of your home?*YesNoAre you required to follow the regulations of an organization such as a Condo or Homeowners' Association?*YesNoLandlord/Homeowner/Association Contact Name*Landlord/Homeowner/Association Contact Phone*Do you have secure screens on your windows?*YesNoDo you have a fenced yard?*YesNoPlease describe your fencing, including the type and height.* Total number of adults (18+ years) residing in your household*Total number of children residing in your household*Please list the ages of all children residing in the household*Do you have children that visit your household?*YesNoPlease list the ages of all visiting children*Is everyone in the household aware that you are interested in fostering animals?*YesNoDoes anyone in the household have animal related allergies?*YesNoHow do they intend to cope with the symptoms of their allergies?* Is anyone in the household immune compromised?*YesNoIs anyone in the household pregnant or planning to become pregnant?*YesNoAnimal OwnershipDo you or anyone in your household currently own any pets?*YesNoPlease list any pets currently residing in your household*SpeciesNameGenderSpayed/Neutered?HealthTemperament Veterinary Clinic Name*Veterinary Clinic Phone*Are the pets currently in the household current on all vaccinations as recommended by your veterinarian?*YesNoUnsureWhat name are the records listed under?*Have you owned any pets in the past five years that are no longer with you?*YesNoPlease list all the pets you have owned in the last five years that are no longer with you*SpeciesNameGenderSpayed/Neutered?What happened? Veterinary Clinic Name*Veterinary Clinic Phone*Were the pets current on all vaccinations as recommended by your veterinarian?*YesNoUnsureWhat name are the records listed under?*Fostering InterestPlease check all that you would be interested in fostering* Kittens too young to fit adoption criteria Puppies too young to fit adoption criteria Under-socialized cats/kittens Under-socialized dogs/puppies Mother cat with kittens Mother dog with puppies Injured or recovering cats/kittens Injured or recovering dogs/puppies Cats/Kittens with an illness Dogs/Puppies with an illness Cats/Kittens that need a temporary home due to overcrowding at the shelter Dogs/Puppies that need a temporary home due to overcrowding at the shelter Cats/Kittens that are stressed and need a break from the shelter environment Dogs/Puppies that are stressed and need a break from the shelter environment I certify that the information I have given is true and I realize that any misrepresentation of facts may result in the loss of my privilege to foster animals. I understand that the Humane Society of Jefferson County has the right to deny my request to foster animals for any situation that would be contrary to the organization’s policies, in violation of state or local ordinances, or not in the best interest of the animal. I authorize investigation of all statements in this application. I also authorize my veterinarian to release any information requested by the Humane Society of Jefferson County.*AgreeDisagreeYou must agree to the above conditions in order to apply to become a foster home.