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W6127 Kiesling Rd | Jefferson, WI 53549

Phone: (920) 674-2048

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Foster Applicationjloberger2025-01-02T16:39:01-06:00

Foster Application

"*" indicates required fields

Personal Information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Date of Birth*

Month

Day

Year

Email*

Primary Phone*

Alternate Phone

Household Information

Are you the owner of your home?*

Yes

No

Is fostering permitted by the homeowner/landlord?*

Yes

No

Total number of adults (18+ years) residing in your household*

Please enter a number greater than or equal to 1.

Total number of children residing in your household*

Please enter a number greater than or equal to 0.

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?*

Are there any pets living in the household?*

Yes

No

Please list any pets residing in your household*

Name

Type/Breed

Age

Gender

Spayed/Neutered?

Fostering Interest

Please check all that you would be interested in fostering*

Cats

Dogs

Small Animals (rabbits, rats, guinea pigs, hamsters, etc.)

Birds (Parakeets, Conures, Cockatiels, etc.)

Release of information - please read carefully)

Please check each box to indicate that you understand and agree to the following terms:*

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 give my consent for the Humane Society of Jefferson County to verify this information.

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.

Applicant's Full Name*

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

Today's Date*

Month

Day

Year

Comments

This field is for validation purposes and should be left unchanged.

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W6127 Kiesling Rd
Jefferson, WI 53549
(920) 674-2048
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