Foster Application

Foster Application

General Information:

First Name: *

Middle Initial: *

Last Name: *

Street Address: *

City: *

State: *

Zip Code: *

Primary Phone Number: *

include area code

Secondary Phone Number: *

include area code

Email Address: *

Birth Date: *

Occupation: *

Employer Name: *

Property Information:

Do you live in a: *

House

Apartment

Duplex

Condo

Mobile Home

Do you own the property at the address above? *

I own

I rent

I live with a parent or guardian

IF YOU RENT, name of landlord/condominium manager:

IF YOU LIVE WITH A PARENT/GUARDIAN, names of parents and phone number(s):

Landlord phone:

include area code

Landlord E-mail (if applicable):

Spouse/Roommate/Partner's name and date of birth (if applicable):

Names & ages of children (if applicable):

Where in the home will the foster animal(s) be kept: *

Caretaker Information:

Who will be the primary caretaker for the foster animal(s)?: *

How long do you anticipate being able to spend with the foster animal(s) each day? *

How long are you willing to foster an animal(s)? *

Willing to foster: *

Cat or Kittens

Dog or Puppies

Breed of Animal:

Pet's Name:

Pet Gender:

Male

Female

Spay/Neuter:

Yes

No

Age:

Still Have?

Yes

No

If no, why not?

Breed of Animal:

Pet's Name:

Pet Gender:

Male

Female

Spay/Neuter:

Yes

No

Age:

Still Have?

Yes

No

Why not?

Breed of Animal:

Pet's Name:

Pet Gender:

Male

Female

Spay/Neuter:

Yes

No

Age:

Still Have?

Yes

No

Why not?

Breed of Animal:

Pet's Name:

Pet Gender:

Male

Female

Spay/Neuter:

Yes

No

Age:

Still Have?

Yes

No

Why not?

Are all of your animals up-to-date on a rabies & distemper vaccinations?

Yes

No

Unsure

Please list your current veterinarian and any veterinarians you have used in the past. We will contact the veterinarian to verify your current pets are up to date on shots. This is a requirement for foster care homes.

Veterinarian Name(s): *

Vet Clinic Name(s): *

Current Veterinarian Phone: *

and/or E-mail:

End Section

Additional Information:

Please provide two non-related references

Reference Name: *

Reference Phone Number: *

include area code

Reference E-mail:

Reference Name: *

Reference Phone Number: *

include area code

Reference E-mail:

By signing this form, I/we acknowledge that the information on this form is true and correct. I/we agree to all provisions indicated on this form. If my/our request for fostering is approved and later Fox Valley Humane Association discovers the above information is not true or correct, this application becomes null and void, and because of my breach of contract, Fox Valley Humane Association reserves the right to remove the foster pet from my home, and I will be held responsible for any associated legal costs incurred as part of said reclamation process. In order to ensure the best foster homes for our rescued pets, we reserve the right to deny any foster application.

Signature: *

Date: *

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Thank you for applying to foster a pet for Fox Valley Humane Association!  Please allow 48-72 hours to process your application.