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Foster Care Application 02.04.14 .pdf


Original filename: Foster Care Application 02.04.14.pdf
Author: Chittenden County Humane Society

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In our attempt to find safe Foster housing for our animals, we require that potential Foster Care
Parents:
1. Provide verification that you are 18 years of age or older.
2. Provide verification on an annual basis that any other animals living in your home are up-todate on vet care and vaccinations.
3. Provide a space in the foster home to keep foster animals quarantined from the other animals
residing in the house for a minimum of 14 days (feline foster only). This is to ensure the health
of all foster animals as well as your animals.

Name____________________________________________________________________________
Street Address:
Mailing Address: (if different than above)
City/ST/Zip:
Home Phone #:
Work Phone #:
Email:

Are you aware of any housing restrictions that may prevent you from fostering for HSCC?
____ I am not allowed dogs

____ I am not allowed cats

____ Limited number of pets allowed

My other animals are:
Name

____ I don’t know

Species

____There are size restrictions
____ No restrictions

Gender

____ Declawed cats only

Other: ____________________

Age

My Veterinarian’s name and contact information: ______________________________________

HUMANE SOCIETY OF CHITTENDEN COUNTY

1 of2

HSCC FOSTER CARE APPLICATION 2014

1.

Please choose (check all that apply) which types of animals you would like to provide foster
care for:
_____ Kittens only
_____ Puppies only
_____ Adult cats only
_____ Adult dogs only
_____ Mother cats and kittens
_____ Mother dogs and puppies
_____No Preference
_____Small animals (circle all that apply): Rabbits / Guinea pigs / rodents / ferrets

2.

Please indicate the length of time you would be able to provide care for (check all that apply):
_____ Short term: less than 1 month
_____ Medium term: 1-3 months
_____ Long term: over 3 months
_____ I have no preference and will provide necessary care on an individual basis.

3.
Please list all people currently living in your household:
Name

5.

Relationship

Age (if under 18)

Will they be interacting with the foster
animals? (Y/ N)

How many hours a day will the animal(s) be left unsupervised?

9.
HSCC strongly recommends that you keep the foster animals (feline only) separate from your
own animals for a minimum of 2 weeks. This will help keep your foster animal(s) and personal pets
safe and healthy during your foster’s initial introduction to your home. What area within your home do
you have available for foster care animals? Please describe:

I certify that the information above is true to the best of my knowledge. I authorize the Humane
Society of Chittenden County (HSCC) to verify the statements contained in this questionnaire. I also
authorize HSCC to contact my landlord or management company and my veterinarian if necessary.

Signature:

HUMANE SOCIETY OF CHITTENDEN COUNTY

____

2 of2

Date

HSCC FOSTER CARE APPLICATION 2014


Foster Care Application 02.04.14.pdf - page 1/2
Foster Care Application 02.04.14.pdf - page 2/2

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