Untitled Document

Foster Care Application

PLEASE PRINT AND BRING WITH YOU

General Information

Name: _______________________________________ Today's Date: _____________
Previous Name (Maiden): __________________________________________________
Spouse/Partner's Name: __________________________________________________
License Number: ________________________________________ D.O.B.: ________
Mailing Address: ________________________________________________________
City: ________________________________ State: _______________ Zip: ______
Resident Address (Only if different from above): ___________________________________________________
City: ________________________________ State: _______________ Zip: ______
How long at present address? _________________________
Please state previous address: ______________________________________________________________________
City: ________________________________ State: _______________ Zip: ______
How long at this address? ____________________________
Home telephone number(s): ______________________________________
Place of employment: _____________________________________________________
Work phone(s): _________________________________________________________
Can you be contacted at work? YES or NO?

1. Do you own or rent your home? RENT or OWN
Circle one: CONDO ONE ROOM APT. TWO ROOM APT. HOUSE TRAILER
SINGLE FAMILY MULTI-FAMILY

Landlord's name and phone number: ______________________________________
2. How many adults are in your household and their full names?

How many children are in your household and their full names?

______________________________________________________________________

Application Questions

What prior experience have your children had with what types of animals?

______________________________________________________________________

What type of contact will your children have with the foster animals?

______________________________________________________________________

3. Is everyone in your household comfortable with the idea of doing foster animal care? Why or why not, please explain.

______________________________________________________________________

4. Does anyone in your family have allergies and/or asthma?

______________________________________________________________________

5. What types of animals have you owned in the past six years?

Species Breed Sex Spayed/Neutered Y/N How long Owned Where Now

______________________________________________________________________

6. What types of animals are currently in your home?

Species Breed Sex Spayed/Neutered Y/N Vaccinated Inside or Outside

______________________________________________________________________

7. Who is your present veterinarian?

Name: ______________________________ Phone: ___________________________

Vet Practice / Clinic's Name and Location:

______________________________________________________________________

8. Have you ever adopted or fostered for UVHS before? Yes or No

What year: ______________ What types of animals? ___________________________

Have you adopted or fostered for any other shelter?

Please list the name of the shelter and what year: Yes or No

______________________________________________________________________

9. Please describe any experience you have with animal training/obedience/medical care/birthing.

______________________________________________________________________

10. Do you have a separate area or room in your home where you can contain foster care animals? Please describe in detail:

_____________________________________________________________________

______________________________________________________________________

11. How long will a foster animal be alone per day at your home?

Day: ___________________ Night: _______________

12. While are at work, will anyone have contact with the foster animal(s), and if so, whom? Please list names and ages:

_____________________________________________________________________

______________________________________________________________________

13. Different animals need to be in foster care for differing lengths of time. What do you honestly feel is the longest period of time you would be willing to keep an animal in your home? _______________________________________________________________

14. Foster care is a temporary agreement, realizing this fact, will you be able to remain emotionally separated able to part with a foster animal(s) when the time comes? Please share your thoughts:

_____________________________________________________________________

______________________________________________________________________

15. Are you prepared to deal with the possible death of a foster animal (natural or by euthanasia)? Please explain:

_____________________________________________________________________

______________________________________________________________________

16. What kinds of animals are you willing to foster

Pregnant cats
Pregnant dogs
Litters of puppies without a mother
Puppies with a mother
Litters of kittens without a mother
Kittens with a mother
Bottle fed puppies
Bottle fed kittens
Feline needing medical care
Canine needing medical care
Canines needing behavioral training/socialization

Additional Comments: _____________________________________________________________________

______________________________________________________________________

17. Why do you feel you would be a good candidate for the Upper Valley Humane Society Foster Care Program?

_____________________________________________________________________

______________________________________________________________________

PLEASE READ BEFORE SIGNING

UVHS reserves the right to verify all information above. Falsification of said information will result in automatic refusal and/or confiscation of said animal at any time during or after foster care.

If, upon completion of this application, UVHS feels you do not meet our foster care criteria, UVHS will refuse said foster care arrangement. Please do not be offended by our questions. These animals require special care and we want to be as careful as possible to place them in appropriate foster care homes.

If you rent an apartment or house, UVHS will call your landlord to see if s/he agrees to your fostering an animal.

I agree to provide a stable and responsible home of any animal I may foster from UVHS. I will follow UVHS guidelines regarding care and regular inoculations. I understand that if I fail to uphold this agreement, UVHS can reclaim the animal and I will return said animal to the shelter, making no claims of any nature.

I give my consent to the veterinary clinics mentioned above to release any information UVHS might request in order to process this foster care application.

Signed: _________________________________________ Date: ____________

Print Name: _______________________________________________________

Thank you for your time and interest in the UVHS Foster Care Program!

Upper Valley Humane Society
300 Old Route 10
Enfield, NH 03748
Located off Exit 15 on I-89
Phone: (603) 448-6888
Fax: (603) 448-0180
info@uvhs.org