Your name:
|
|
Current date and time:
|
|
Home address (Street Name, Street Number, City, State, and Zip Code):
|
|
Home phone:
|
|
Cell phone:
|
|
Email:
|
|
Your employer:
|
|
I am interested in(Check all that apply)
|
Short term fostering(1 month)Long term foster(>1 month)
|
If you chose short term or long term, are you interested in(select all that apply)
|
Bottle BabiesBaby KittenMom And Her LitterRehabHospice
|
Name and age all of household residents:
|
|
Who will be primarily responsible for the animal?:
|
|
Do you live in A:
|
|
Do you rent, own, or live with parents:
|
|
(If you own just put N/A) Landlord name and phone:
|
|
Are you willing to work through behavioral problems with fostered animal?:
|
|
Do you understand that your fostered animal may expose your resident animals to shelter related illnesses?:
|
|
Have you ever had to give an animal away?:
|
|
What were the circumstances?(if you never have put N/A)
|
|
Where will foster pets be residing?:
|
|
List current pets and any pets that you have had in the past 5 years:
|
|
Current/past 5 years pet breed, type, gender, age, spayed/neutered?:
|
|
What is your veterinarians name and phone number?
|
|
If current pets are not up to date on vaccines or altered, explain why(If they are put N/A)
|
|
Have you fostered with us or any other organization before?
|
|
If yes, when and where?(If no put N/A)
|
|
Are you willing to have a Humane Society representative perform a home check? (If no explain why)
|
|
Foster animals are property of the Humane Society, do you agree to return the fostered animal at the end of the agreed upon foster terms.
|
|
I agree that this animal is my responsibility and i will follow the rules given by wicomico humane staff
|
|
I will be financially responsible for any injury or incident that occurs while the animal is under my care.
|
|
I agree to keep the dog on a leash at all times or in a fenced in area
|
|
I agree that I will not try to socialize dogs that are deemed reactive.
|
|
I will report any concerns (behavior or health) back to the shelter immediately. if warranted, call animal control at 410-749-1070 or the shelter at 443-880-1788.
|
|
Any additional comments(explain why you chose other)(If none put N/A)
|
|
Sign and date:
|
|
|
|