HSU

FOSTER CARE APPLICATION

( 7 27 07)

I am willing to foster the following:

Kittens_____ Puppies ______   Bottle Babies _____   Other (be specific) ______________

Pregnant Cat _____ Pregnant Dog______ Adult Cat _____ Adult Dog _______

Foster Parents name _______________________________________________________________

Address __________________________________________________________________________

City, State, Zip _____________________________________________________________________

Home Phone ________________________   Cell or work phone ______________________________

1.        Are you   active in any animal organization?      Yes ___   No___

2.       If    yes, which one? ______________________________________________________________

3.        Why would you like to foster for HSU ? _______________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________

4.       Does your residence have any deed restriction in regard to pet ownership? ______________

 If you rent, does your lease agreement allow pets? ___________

Do you have a completely fenced yard?  ___  If not, are you willing to leash walk? _____

Number and age of children in your home _______________________________

 Are there elderly people residing in your home? ____________

6.       Would there be anyone home during the day?   Yes   ___  No ___  If yes, who? _____________________

7.       Do you have any animals at your home now?  Yes___  No ____

List name _____________ Breed______________ Sex ____ Current on Vaccinations? Yes ___  No ____

(Use back of this page   for multiple listings)

8.        Which animal hospital / clinic do you or have you used?  ________________________

9.       Where will the foster animal (s)   be kept when no one is home?     Indoors _____ Outdoors _____

Details: ____________________________________________________________________________________

I, _________________________________________ agree that all the information that I have

                                                                                       (     Please   print your name)

 given   is correct as written,   I am at least 18 years of age and I authorize the HSU

to verify any information.

I understand that  HSU purposes to provide healthy friendly pets in this program

 and any damages whatsoever incurred  by or resultant of fostering of this animal

remains the sole responsibility of the adoptive parent.

Foster’s signature______________________________________________________________

          Date_______________________

           HSU ______________________