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