EmailMe Form - HELP the Animals Foster Application

PERSONAL INFORMATION

Name *

First Last

If you are a couple that will share responsibility, please enter both first names (i.e., Jane and John)

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Home Phone

### - ### - ####

Mobile Phone

### - ### - ####

Work Phone

### - ### - #### Ext. ###

You must enter at least one phone number so we can contact you directly, other than by email.

Preferred Phone *

Email Address *

Confirm Email Address

HOUSING INFORMATION

Do you own your home, rent, or live with relatives? *

Landlord's Name

Landlord's Phone

### - ### - ####

Landlord Notes/Instructions (optional)

Please enter any special instructions or notes about contacting your landlord. For example, if only available certain days of the week or hours of the day.

FOSTER PREFERENCES/INFORMATION

I am interested in fostering *

Would you allow HELP the Animals to conduct a home inspection? *

Yes

No

Do you have a yard?

Yes

No

Is your yard fenced?

Yes

No

Do you currently share your home with any pets? *

Yes

No

Number of Dogs

Number of Cats

Number of Other Animals

Please tell us what type in the next field.

Other Animals

Have you considered how your animals will react to bringing a new animal into the house? *

Yes

No

Veterinarian Name *

Veterinarian Phone *

### - ### - ####

SPECIAL NEEDS ANIMALS

Are you comfortable sharing your home with special needs, pregnant, or newly born animals? *

Yes

No

Do you have any experience with:

Pregnant Animals

Nursing Animals

Bottle Feeding

Special Needs

Please tell us what experience you have in this area. Experience is NOT required - it just helps us match animals with the right foster home, or schedule training if needed.

Please describe your experience:

Are you willing to receive instruction about how to deal with infant or young animals, including care and training?

Yes

No

BEHAVIORAL ISSUES/TRAINING

Are you interested in fostering animals that have behavior problems or require training? *

Yes

No

Have you trained dogs or cats in the past? *

Yes

No

Are you comfortable with dogs that may be considered aggressive? *

Yes

No

Are you comfortable with dogs that are considered shy? *

Yes

No

Are you comfortable with dogs that may be considered high energy? *

Yes

No

MEDICAL ISSUES

Are you comfortable with an animal that needs medication? *

Yes

No

Are you able to give medication?

Pills/Liquid Only

Shots

All Medications

GENERAL QUESTIONS

Are there any types of animal or breeds that you would NOT consider fostering? Please explain.

How much time will you spend with your foster animal daily? *

How much time will the animal spend alone daily? *

What will you do with the animal when you are not at home? *

Comments, Notes or Additional Info:

Use this field to enter any additional information that you think would assist us in reviewing/approving your application. This could be referral information, references, special circumstances, etc.

ELECTRONIC SIGNATURE & ANTI-SPAM

I certify that all the information submitted on this foster application is true and complete. I understand that if any false information, omissions, or misrepresentations are discovered, my foster agreement may be rejected and may be terminated at any time.

Signature *

Please type your full, legal name to sign this application.

Date *

MM / DD / YYYY