Foster Home Care Volunteer Application

All fields are required.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Daytime Phone(Required)

Other Pets in Household(Required)

Please identify all dogs/cats/other pets currently living in your home.

Household Information(Required)

Household Information

Own Home

Apartment

Condo

Farm

Other

Landlord Info(Required)

If you rent, provide landlord's contact info, including phone number and/or email address.

Veterinarian Reference(Required)

If you currently own animals, please list your veterinary reference where vaccination records can be found, veterinary phone number, and whose name they are under.

Vet's Awareness(Required)

Does your veterinarian know you plan to become a foster parent?

Yes

We suggest that you inform your veterinarian.

Vaccination Info(Required)

Are all of your animals current on their vaccinations?

Yes

Please upload copies of current vaccination records at the bottom of this form, or have your veterinarian fax them directly to the attention of the Foster Home Coordinator at (715) 634-5394.

Vax records unavailable(Required)

Please provide estimated date of when vaccinations will be current and forward at that time.

Required Vaccinations: ALL animals in the home must be vaccinated for Rabies and Distemper. Recommended vaccinations include:

Bordatella vaccinations are highly recommended for all dogs in the home.
Feline Leukemia vaccinations are highly recommended for all cats in the home.

Children in Home(Required)

How many children live in or visit your home?

Allergies(Required)

Does anyone in the household have pet allergies?

Yes

Allergies Controlled(Required)

If yes, are allergies controlled?

Animals Left Alone(Required)

How many hours/day would animals be alone?

Frequency of Travel(Required)

Do you travel frequently?

Family Members Assisting(Required)

List any members of the family that may assist in caring for the animals.

Names of All in Household(Required)

Please list names (first and last) of all people living in your household.

Isolation Area(Required)

Do you have a room to isolate foster animals from other pets?

Caring for Sick Animals(Required)

Describe your experience in caring for sick or injured animals.

Canine Placements(Required)

I would be willing to offer a foster home for the following canine placements:

Feline Placements(Required)

I would be willing to offer a foster home for the following feline placements:

Foster Home Visit(Required)

The best time for our family to schedule a NHS Foster Home Visit would be:

Motivation for Fostering(Required)

What motivation do you have in wanting to foster animals?

Files

Please upload any applicable documents.

Drop files here or

Max. file size: 512 MB.

In consideration of NHS accepting or denying my application for participation in the foster Home program, I agree to release and hold NHS harmless from and against any and all loss, damage, claims, liability, costs and expenses, of any nature whatsoever, including without limitation attorney's fees and disbursements. I further agree to indemnify NHS for any of the foregoing asserted by third party, including but not limited to, other individuals residing at my home, to the extent that any of the foregoing arise from or are occasioned by my participation in the foster home program. I understand that when I care for NHS animals in my home, I am doing so strictly as a volunteer and in the spirit of volunteerism. Thus, I will not expect to make claim for wages in return for my services. I agree that NHS may photograph my participation in this program, and I hereby release any such photographs to NHS for use in its programs, publications, and purposes.

By typing my name and date in the boxes below, I acknowledge I am providing accurate information to NHS.

SIGNATURE(Required)

SIGNATURE

Date(Required)

DATE

Challenge(Required)

To submit this form, you must type the word FOSTER below to prove you are human, then click on Submit.

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