PCHS ONLINE FOSTER APPLICATION

If you would prefer to print this form and bring it to the shelter, you can print a copy here.

Please take the time to answer all questions completely.
Note: all applicants must be 18 years of age or older
Applicant Name:
Street Address: Apt #:
City: State: Zip:
Driver's License Number: State of Issue:
Birthdate:
Home Phone: Work Phone: Cell Phone:
Email Address:
Applicant's Occupation/Place of Employment:

Your home is a: HOUSE APARTMENT TOWNHOUSE MOBILE HOME OTHER
   If other, please specify:
Do you RENT or OWN your home?
   If you rent, we will need to contact your landlord or management company.
   Please provide their name and telephone number:
   
How many adults live in your household? Children? How old are the children?
Does everyone in your household support your participation in a foster program? YES NO
Is anyone in your household allergic to or afraid of dogs and/or cats? YES NO
   If yes, please tell us who is allergic to which animals:
   

Please describe the area of your household where the foster animal(s) would be kept:
Do you have a fenced yard? YES NO
   If yes, what type of fence?
If you foster a cat or kitten, will you be willing and able to keep it indoors at all times? YES NO
How long would the animal(s) be left alone each day?
Do you have a car available at all times? YES NO
Would you be able to transport the animal(s) to a veterinarian in an emergency situation? YES NO

Do you currently have pets in your household? YES NO
   If yes, please list the species, number, and ages
   
Who is your regular veterinarian? Phone Number: Are all of your current pets up-to-date on vaccinations? YES NO N/A
Are all of your current pets spayed or neutered? YES NO N/A
   If no, please explain:
   
If you have cats, have they been tested for FIV and Feline Leukemia (FeLV)? YES NO N/A
   If yes, what were the results of these tests?
   Are your cats vaccinated against these diseases YES NO N/A
If you have ever had a pet die at an early age or due to an accident, please explain:
   
Do you have an area where foster animals could be isolated from your own animals if necessary? YES NO

Please briefly explain why you would like to foster animals for the Pulaski County Humane Society:

When would you be able to start fostering?
Are there any restrictions on how long you can foster? YES NO  If yes, please explain:
Are you currently fostering for another organization? YES NO  If yes, please explain:
Please indicate which types of animals you'd be willing to foster:

Dogs
Cats
Nursing Mothers with Babies
Orphaned Babies
Young Animals
Adult Animals

Elderly Animals
Animals with Minor Injuries
Animals with illnesses (may require medication or quarantine!)
Animals that need Socialization


Please tell us about any present or previous volunteer experience:

Do you have any experience with animal care that might be useful for your work as a foster volunteer?

Have you had any first aid training? YES NO  If yes, please explain:
In your opinion, what physical symptoms and/or behaviors would warrant immediate medical attention?


Would you be willing to adopt your foster animal if no permanent home can be found? YES NO

Are you willing to take the foster animal to vet appointments made by PCHS? YES NO

Are you willing and able to administer medications should the animal require them? YES NO

If your foster animal was ill or injured, and the veterinarian and PCHS concluded that it needed to be put to sleep, would you support our decision? YES NO

Are you prepared for the financial commitment required to be a foster? YES NO

Please list two references (mandatory for consideration - do not list anyone related to you):
  Reference #1
      Name:       Relationship to Applicant:
      Contact Information (phone, email, etc.):
  Reference #2
      Name:       Relationship to Applicant:
      Contact Information (phone, email, etc.):


ACKNOWLEDGEMENT:

  1. I wish to volunteer and provide a foster home for the Pulaski County Humane Society.
  2. I fully understand that whenever my volunteer work involves contact of any kind with animals, there is a risk that I may be scratched, bitten, or may come into contact with a diseased animal, and I accept this risk and will not hold the Pulaski County Humane Society or any of its representatives responsible in any way for any injury or illness that I or other members of my family/household may incur.
  3. In consideration for the opportunity to perform volunteer work for the Pulaski County Humane Society, I agree to fully release the Pulaski County Humane Society and its officers, volunteers, or agents, from any and all liability for any damage or injury, whether arising from this contact or a breach thereof or from any act of negligence or gross negligence by the Pulaski County Humane Society, its officers, volunteers or agents.
  4. I understand that all Pulaski County Humane Society information given to me and all information that I will be privy to in the course of my volunteer work is of a confidential nature, and I agree that I will not disclose such information to any individual or group.
  5. I understand that it is my responsibility to acknowledge and respect all rules, regulations, practices, procedures, and policies of the Pulaski County Humane Society.
  6. I understand that I will be required to sign a Foster Agreement for each foster animal placed in my care.
  7. I have read this agreement, and I fully understand and agree to abide by its terms.
  8. I acknowledge that the above information is correct to the best of my knowledge and that I am 18 years or older.

By submitting this form, I hereby state that I have never been convicted of animal cruelty, neglect, or abandonment of any animal or animals. I certify that the above information is correct, and I understand that the Pulaski County Humane Society has the right to verify this information.

ELECTRONIC SUBMISSION OF THIS APPLICATION WILL SERVE AS A SIGNATURE