Foster Caretaker Application Form : Get Involved : Capital Humane Society

Name (Required)

Address (Required)

Apt

City (Required)

State (Required)

Zip (Required)

Driver's License # (Required)

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State (Required)

Employer (Required)

Daytime Phone # (Required)

Evening Home # (Required)

Email Address (Required)

*majority of communication will be through email*

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?

Yes
No

Ages (if selected yes above)

Have you ever turned an animal over to an animal shelter

Yes
No

If yes, what were the circumstances?

Do you have any pets at home now?

Yes
No

(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?

Yes
No

*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)

Would there be anyone home during the day?

Yes
No

Has anyone in the household ever had allergies to animals?

Yes
No

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

Yes
No

If yes, describe

Do you have a fenced yard?

Yes
No

What are you interested in fostering?

Kittens with Mom
Adult Cat
Puppies with Mom
Adult Dog
Kittens
Puppies
Other animals

Other animals willing to take?

1. Reference Name (Required)

1. Reference Phone (Required)

2. Reference Name (Required)

2. Reference Phone (Required)

1. Name

Cat/Dog

Cat
Dog

Breed

Age

2. Name

Cat/Dog

Cat
Dog

Breed

Age

3. Additional pets

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

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

*please enter name*

Foster Care Application