Northwoods Humane Society                                               Foster Home Care Volunteer Application Name(s):___________________________________Home Phone:__________________ Address_________________________________________________________________ City_______________________________ State_____ Zip Code____________________ Daytime Phone___________________ May we contact you at this number? __________ Please note: For the benefit of the animals, we’ll continue to call other volunteers if we are not able to contact you right away. Please identify all dogs/cats that currently live in your home        spayed/neutered Breed ______________ Name_______________ Age____ Sex____  yes  /  no Breed______________  Name_______________ Age____ Sex____  yes  /  no Breed ______________ Name_______________ Age____ Sex____  yes  /  no Breed ______________ Name_______________ Age____ Sex____  yes  /  no Any other pets? __________________________________________________________ Name of Veterinarian_________________________ phone number________________ Does your Veterinarian know you plan to become a foster parent? ____ If no we suggest that you inform your veterinarian.                                                                   Recommended Vaccinations Required Vaccinations                                         These vaccinations are highly recommended for your pets All animals in the home must be vaccinated           Dogs – Bordetella For Rabies and Distemper                                 Cats – Feline Leukemia Are all of your animals current on their vaccinations?    Yes  /  no If yes, please attach copies of current vaccination records or have your veterinarian fax them to us at 715- 634-5394 to the attention of the foster home coordinator. If no, please provide estimated date of when vaccinations will be current and forward records at that time. ________________________________________________ Household Information __ Own Home   ___ Apartment   ___Condo   ___ Farm   ___ Other _________________ Landlords name_________________________ Phone____________________________ How many children live in or visit your home?______ Ages ______________________ Is anyone in the household allergic to pets? ____ If yeas are allergies controlled?______ List any members of the family that may assist in caring for the animals______________ Do you have a room to isolate foster animals from other pets ______________________ If yes, please describe the area and how you would isolate them____________________ How many hours per day would animals be alone?_______Do you travel frequently?___ Animal Handling Experience Describe your experience in caring for sick or injured animals. Please note any experience you have in dog obedience training or behavior modification:_____________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ What motivation do you have in wanting to foster animals?_______________________ ________________________________________________________________________ ________________________________________________________________________ I would be willing to offer a Foster Home for the following placements: Canine Placements;  __ single puppy  __ litter of puppies  __  mom with puppies __ adult dog  __  large breeds  __  small breeds  __  injured & recovering from surgery __  minor illness  __  active, in need of manners  __  not house-trained __  need socialization  __  may exibit separation anxiety  __  food possessiveness Feline Placements:  __  single kitten  __  small litter  __  litter any size  __  adult __  mom with kittens  __  injured & recovering from surgery  __  upper respiratory infections  __  not litter trained  __  needs socialization The best time for our family to schedule a NHS foster home visit would be:______ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Foster Home Care Waiver of Liability In consideration of NHS accepting or denying my application for participation in the foster home program, I agree to release and hold NHS harmless from and against any and all loss, damage, claims, liability, costs and expenses, of any nature whatsoever, including without limitation attorney’s fees and disbursements. I further agree to indemnify NHS for any of the foregoing asserted by third party, including but not limited to, other individuals residing at my home, to the extent that any of the foregoing arise from or are occasioned by my participation in the foster home program. I understand that when I care for NHS animals in my home, I am doing so strictly as a volunteer and in the spirit of volunteerism. Thus, I will not expect to make claim for wages in return for my services. I agree that NHS may photograph my participation in this program, and I hereby release any such photographs to NHS for use in its programs, publications, and purposes. Signature_____________________________________ Date__________________