PLEASE NOTE:

Adoptions at our Pieloch Pet Adoption Center will be by appointment only to follow recommendations from local and national health authorities regarding social distancing. To make an appointment please call our Pieloch Pet Adoption Center at (402) 441-4488 ext 1. Our Admissions & Assessment Center is open but is only allowing one customer/party in the building, at a time. Please be patient, as our staff works to assist you. We ask for visitors to please wear a mask and practice social distancing when visiting either of our locations.

Bottle Baby Foster Application

Name (Required)

Address (Required)

Apt

City (Required)

State (Required)

Zip (Required)

suym5rwnxxj2

Driver's License # (Required)

State (Required)

Employer (Required)

Daytime Phone # (Required)

Evening Home # (Required)

Email Address (Required)

*majority of communication will be through email*

Have you ever been convicted of a crime?

Do you live in a...

Condo/Townhouse
Apartment
Duplex
Mobile Home/House

Do you...

Rent/Lease
Own your residence

Name and Phone Number of Landlord/Owner (Required)

How long have you been at this address? (Required)

How many adults reside in the household? (Required)

Are there any children in your home?

Ages (if selected yes above)

Have you ever turned an animal over to an animal shelter

If yes, what were the circumstances?

Do you have any pets at home now?

(Pet 1) Name, Breed, Age, Sex

(Pet 2) Name, Breed, Age, Sex

(Pet 3) Name, Breed, Age, Sex

(Pet 4) Name, Breed, Age, Sex

Are your pets current on vaccinations and licensed?

*If no, they must be before fostering.*

What Animal Hospital/Vet Clinic do you (or did you) use? (Required)

Approximate date and reason for last vet visit? (Required)

Will you be able to tend to kittens every four hours?

Has anyone in the household ever had allergies to animals?

Is there room in your home where you can keep foster animals confined separate from your own?

If yes, describe

Do you have experience caring for bottle baby kittens?

If yes, please explain.

List two references (people who know you and your ability to care for pets):

1. Reference Name (Required)

1. Reference Phone (Required)

2. Reference Name (Required)

2. Reference Phone (Required)

How did you hear about the bottle baby foster care program? (Required)

I agree that all the information which I have given the Capital Humane Society is correct. (Required)

*please enter name*

If you have any questions, please contact:

Lauryn Nobbe, LVT

Foster Care Coordinator

foster@capitalhumanesociety.org

402-477-3270