Foster Application In order to be considered for the foster program, you must: Be 21 years of age or have a cosigner present at the time of turning in an application. Have formal identification (ex. drivers license). Current pets must be up to date on vaccinations. SWCHS will check with landlords for approval of pets in rental homes, apartments, and mobile home parks. Parental permission must be granted if you live in their home at the time of the application. * I have read and understand the above statements. Foster Questions Please indicate which animals you would be interested in fostering (check all that apply): * Cat - Mom & Nursing Babies (possibility of fostering for 12 weeks) Senior Cat Cat Medical Issues Cat Over Population Cat(s) Requiring Socialization Dog - Mom & Nursing Babies (possibility of fostering for 12 weeks) Dog Medical Issues Dog Over Population Dog(s) Requiring Socialization Please indicate what type(s) of animals you would be interested in fostering (check all that apply): * Canine Feline Other (small animal) Animal Name (if applicable)Animal Name (if applicable) Name and Address Information Name: * Date of Birth: * Address: * City: * State: * AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip: * Primary Phone Number * Secondary Phone Number Drivers License #: * Spouse/significant other (if applicable): Email* Your email address may be added to SWCHS mailing lists. Financial/Employment Employer/Source of income: * Phone: * Employment Status: * Part Time Full Time For how long? Supervisor's Name: Home Environment How long are you gone during the day? * At night? * Do you live in a _____? * House Mobile Home Apartment Condo Duplex Farm Do you _____? * Rent Own Live with parents/relatives Landlord/Manager/Parent’s Name: Landlord/Manager/Parent's Phone Number: Renters, have you consulted with your landlord yet about having a pet? Yes No Will be soon Have you ever been convicted of a crime other than a minor traffic violation or any animal related violations? * Yes No If yes, explain: Has anyone in the household in which the animal may live been convicted of an animal related crime? Yes No If yes, explain: Do you or anyone else in your household have any allergies to animals? Yes No Do you have children that will be in the household with this animal? Yes No If yes, provide ages: Names of people, over the age of 18, who live in the household or who visit on a regular basis: Name (First and Last) Birth Date Add Remove Specific animal requested How did you learn about this animal? SWCHS website Facebook Newspaper Word of mouth What about fostering interests you? * Where will you keep this animal primarily? * Indoors Outdoors Both Are there any behavior issues you would find difficult to work with? * If you previously owned pets in the last three years, but no longer have them please indicate why (check all that apply): Given to family member/another person Given to rescue/shelter Ran away Passed away Please list all CURRENT pets in the household: Name Breed Age (yr) M/F Male Female Altered? Yes No Owned (yr) Add Remove Current Animals Are your pets current on their vaccinations? Yes No Are your pets licensed? Yes No Name of veterinarian: Phone Have you ever attempted to foster from a shelter or rescue before? * Yes No If yes, which shelter/rescue? Emergency Contact Name (First and Last) * Primary Phone Number * Secondary Phone Number (if applicable) Address Relation To You * EX: parent, relative, family friend, personal friend, etc. Add Remove South Wood County Humane Society has the right to accept or deny this application for any reason. A completed application does not guarantee an approved application. I certify that I am at least 21 years of age and the information given is true. I authorize any and all verifications of statements made in the application. I recognize that any misrepresentation of facts may result in losing the privilege of fostering an animal. I understand that SWCHS will provide supplies and make all decisions about medical attention for my SWCHS foster animal(s). I understand that I am responsible for all aspects of the daily care of my SWCHS foster animal. I also understand SWCHS has the right to do a follow up visit and take pictures showing proper shelter is being provided for any animal kept outside. If the animal(s) I am fostering become ill, injured, or lost, I will contact SWCHS immediately. I understand how the foster process works, agree to complete any spay/neuter requirements, and to pay fees involved with adoption if the foster pet does not return to SWCHS. Upon approval of this application, a physical signature may be required. * By checking this box, I verify that I have read and agree to the above statement. Submit Δ
