Foster Care Application

Henry County Humane Society, Geneseo

Date:__________________

What type of animal(s) are you interested in fostering?

Orphaned Kittens Pregnant Cat Adult Cat

Orphaned Puppies Pregnant Dog Adult Dog

Foster parent's name:

Address: City: State:

Home phone: Work phone: Cell phone:

1. Are you a part of any animal organization? Yes No If yes, which one?
2. Why would you like to foster?
3. Do you live in a: Condo/Townhouse Apartment Duplex Mobile Home House
4. Do you: Rent/Lease Own

   If you rent, is your lease: Yearly Monthly

   Name of complex and/or association:

   Name and phone number of landlord or owner:

   Pet policy:

   How long have you been at this address?
   

5. How many adults reside at this address?

   Are there children in your home? Yes No

   If yes, how many and what are their ages?

6. Would there be anyone at home during the day?  Yes No
   

   If yes, who?

7. Do you have any dogs and/or cats at home now? Yes No
   

   Age:	Breed:	Sex: Male Female	Licensed: Yes No
   Age:	Breed:	Sex: Male Female	Licensed: Yes No
   Age:	Breed:	Sex: Male Female	Licensed: Yes No

   Pets name(s)

   Approximate date and reason of last vet visit:

8. Have you had other pets in the past 5 years? Yes No

   Age:	Breed:	Sex: Yes No	Disposition:	Pet's name:
   Age:	Breed:	Sex: Yes No	Disposition:	Pet's name:

    

9. What animal hospital/clinic do you (or did you) use?
10. Where will the foster animal(s) be when no one is home? Indoors Outdoors
11. Where will the foster animal(s) sleep? Indoors Outdoors

I, __________________________, agree that all of the information which I have given above is correct as written and I authorize the Henry County Humane Society - Geneseo to verify any information.

Date ______________________

Volunteer Signature ____________________________