Foster Application

Personal Information

Legal Name*

First Middle Last

Home Address*

Street Address Address Line 2 City State ZIP Code

Date of Birth*

MM

DD

YYYY

Email*

Primary Phone*

Alternate Phone

Employer

Work Phone

Work Schedule

Household Information

Are you the owner of your home?*

Yes
No

Are you required to follow the regulations of an organization such as a Condo or Homeowners' Association?*

Yes
No

Landlord/Homeowner/Association Contact Name*

Landlord/Homeowner/Association Contact Phone*

Do you have secure screens on your windows?*

Yes
No

Do you have a fenced yard?*

Yes
No

Please 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?*

Yes
No

Please list the ages of all visiting children*

Is everyone in the household aware that you are interested in fostering animals?*

Yes
No

Does anyone in the household have animal related allergies?*

Yes
No

How do they intend to cope with the symptoms of their allergies?*

Is anyone in the household immune compromised?*

Yes
No

Is anyone in the household pregnant or planning to become pregnant?*

Yes
No

Animal Ownership

Do you or anyone in your household currently own any pets?*

Yes
No

Please list any pets currently residing in your household*

Species	Name	Gender	Spayed/Neutered?	Health	Temperament

Veterinary Clinic Name*

Veterinary Clinic Phone*

Are the pets currently in the household current on all vaccinations as recommended by your veterinarian?*

Yes
No
Unsure

What name are the records listed under?*

Have you owned any pets in the past five years that are no longer with you?*

Yes
No

Please list all the pets you have owned in the last five years that are no longer with you*

Species	Name	Gender	Spayed/Neutered?	What happened?

Veterinary Clinic Name*

Veterinary Clinic Phone*

Were the pets current on all vaccinations as recommended by your veterinarian?*

Yes
No
Unsure

What name are the records listed under?*

Fostering Interest

Please check all that you would be interested in fostering*

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.

Entering your name below indicates that you understand and agree to the above terms.

Applicant's Full Name*

Date*

MM

DD

YYYY

Foster Application

Personal Information

Household Information

Animal Ownership

Fostering Interest

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