Hurricane Pets Rescue Inc.

Foster Parent Screening Application

We are Paw Obligated to Check You Out!

Today's Date

Name of pet you will be fostering (if known leave blanc)

Will you allow a Hurricane Pets representative to do a home visit?select one

YesNo

Can you commit to fostering a pet for at least one year?select one

YesNo

If the above answer is no, for how long can you commit to foster the pet?something more

Your Namefull name

Date of birth(Over 18)

Address

City

State

Zip Code

Emaila valid email

Home Phone #ex: (555) 555-5555

Mobile Phone #ex. (555) 555-5555

Employedselect one

YesNoRetiredSelf Employed

Employer Address

Type of ResidenceSelect if you rent or if you own and type of residence.

RentOwnLive with parentsLive with roommatesApartment HouseCondoTownhomeMobile Home

How long have you lived at your present address?

Are you planning to move soon?

Yes No

If planning to move soon, when?

Do you live in a high rise building?

Yes No

If checked "Yes" above. What Floor?

Do you have a balcony?select one

Yes No

If yes, is your balcony screened?

Yes No

Do you have a backyard?select one

Yes No

If yes Is your backyard fenced?select one

YesNo

Landlord NameONLY IF YOU RENT

Landlord Tel. #(555) 555-5555

Landlord E-Mail

Landlord permission to have a petselect one

Yes No

Landlord’s Initials for Consent to have a petLandlord Signature

Type and Number of pets allowed

ADDITIONAL INFORMATION

Number of adults in your family.

# of Children

If Children Specify Ages

If foster a pet, who will be the primary caregiver for the pet?

Is anyone in your home allergic to pets?select one

YesNo

Where will the pet be once in your care:select one

InsideOutsideBoth

Do all members of your household agree to you fostering a pet?

YesNo

If you foster a cat, where will you place the litter box?

If you foster a dog, how many times would you will walk the dog?

If you foster a dog, what is the average time the dog will spend outdoors?

Do you or anyone in household smokes?select one

YesNo

If the answer above is "Yes", Where does the smoking take place in your home.select one

indoorsoutdoorsindoors and outdoors

Do you have a pet door in your home?select one

YesNo

Will you commit to take the pet to the vet when needed?select one

YesNo

If you foster a dog, where would the dog sleep?select one

IndoorsOutdoorsOther

If "Other" above please explain:something more

Which word or words best describes your home/lifestyle?select all that applies

LaidbackHigh-energyQuiet/calmBustlingNoisyBusyNot home muchHome all the time

How Many animals do you have in your home presently?

INFORMATION ON YOUR CURRENT & PREVIOUS PETS.

List all current Pets Below:

Pet # 1: Name

Speciesex. Dog, Cat, Rabbit, etc.

Age & Years owned or fostered?

Pet # 2: Name

Speciesex. Dog, Cat, Rabbit, etc.

Age & Years owned or fostered?

Pet # 3: Name

Speciesex. Dog, Cat, Rabbit, etc.

Age & Years owned or fostered?

Are all the listed above pets in the household spay and neutered?select one

YesNo

I the answer above is "NO" please explain:

Additional PetsList them here.

Are all fosters and owned cats in your household presently tested for FELV and FIV?select one

YesNo

When was the last time the cats where tested for FELV and FELV:select one

A month ago3 months agoOver a year agoOver 5 years ago

Please check FELV-FIV test results:select one

PositiveNegative

Do you keep FELV’s and FIV’s together?

Have you ever had to surrender an animal to a shelter?select one

Yes No

If the answer above is YES, please explain:

Are there dogs currently? If the answer is yes, are your dogs tested for Heartworm?select one

Yes No

Heartworm test results?select one

PositiveNegative

Are all dog in your household on Heartworm preventive?select one

YesNo

Are all dogs and or cats presently in your home treated with monthly flea medications?select one

YesNo

What flea medication products do you use?

When was the last time your pets and fosters were dewormed?

VETERINARIAN INFORMATION

Veterinarian’s Name:and Last Name:

Address:

City:

State

Zip Code:

Phone #:ex. (555) 555-5555

Fax #:ex. (555) 555-5555

Emaila valid email

PET RELATED

What would you do if the pet scratches or chews on furniture?

When walking the pet (dog) would you keep him-her on a leash or let it run free?

What will you do if the pet urinates on the furniture or carpet?

What would you do, if a new boyfriend or girlfriend moves in with you or you are marry or re-marry a new partner, and you find out that your new partner is allergic to the pet?

What will you do with the pet if a new baby arrives?

How many times a day would you feed your pet?

What type of food would you feed your pet?select one

Wet Food (can)Dry Food (kibble)

If you travel who will take care of the pet in your absence?

Will you return the animal to Hurricane Pets if you can no longer take care for the pet?select one

YesNo

In a DISASTER (hurricane, tornado, earthquake, etc.), would you leave the pet alone at home if you had to go to a shelter?select one

YesNo

Please explain what would you do with the pet, in the event of a Mother Nature or Man made disaster ?

Have you fostered for another rescue groups before or shelter?

Please provide the name & telephone number for the rescue group (s) or shelter you have fostered for before:

If you are a 501C3 organization that want to partner with us, please attach your IRS determination letter in the field below.

Upload 501 C3 determination letter here.uploader

Upload

What is your preference for fosteringselect all that applies

PuppiesAdult Dogs:CatsKittensSenior CatSenior DogsSpecial Needs Other species

If other species checked above, please specify:

Please specify above what type of special needs:pets if any your will like to foster:for ex.: FIV+, FELV+, HW+, Handicap pets, etc.

What is your experience in fostering Special Needs pets:

Do you have experience with neonatal pets (newborns)?select one

Yes No

Please describe your experience with orphan kittens-puppies:

If you are a private rescuer and adopt pets out on your own, what is your criteria for adopting pets:

Please provide a personal reference not related to you below.

Name and Last Name:full name

Telephone #:ex. (555) 555-5555

Emaila valid email

What do you think of this statement: Any home is better than no home at all, or better than being euthanized at a shelter?

WE RESERVE THE RIGHT TO REFUSE ANY APPLICANT - PLEASE READ INITIAL AND SIGN BELOW:

PLEASE NOTE:

ONCE YOU COMMIT TO FOSTER AN ANIMAL(S) IF A PROBLEM ARISES YOU CANNOT JUST CALL US AND SAY: THE ANIMAL(S) NEED TO GO TOMORROW YOU NEED TO WORK WITH THE PROBLEM AND GIVE HPR A 90 DAY NOTICE FOR FINDING ANOTHER FOSTER HOME, NOTICE SHOULD BE GIVEN IN WRITING.
UNDER NO CIRCUMTANCES THE ANIMAL OR ANIMALS YOU FOSTER FOR HPR CAN BE TRANSFERRED TO ANOTHER FOSTER HOME, OTHER RESCUE GROUP OR ADOPTED OUT WITHOUT OUR WRITTEN AUTHORIZATION.

WE RESERVE THE RIGHT TO REFUSE ANY APPLICANT PLEASE READ AND SIGN:

All the information I have given on this application is true and complete.

Once this application is approved fully approved a separate binding foster contract will need to be signed between you (the foster) and Hurricane Pets Rescue (HPR) but in addition you will agree to the following: I agree to provide responsible care to include but not limited to proper nutrition, sanitation, routine and necessary veterinary care to any animal I foster for HPR. I agree that the animal will reside inside (depending on the type of animal) my home as a pet.

I understand that "Hurricane Pets" is not responsible for the accuracy of information received about the temperament, habits, or physical condition of foster animals, although we try our best to get as much information on the animal as we can before intake. I understand that it is my responsibility to evaluate the animal myself before agreeing to foster.

I am in full agreement with the terms and conditions of fostering of the animal.

Hurricane Pets will in no way be liable or responsible for any damages, accidents, injuries, or human medical expenses resulting from fostering an animal.

I understand and agree to provide food and litter for the animal (s) I foster is my responsibility.

I understand that HPR will provide all medical for the animal or animals in my care.

I understand and agree that it is my responsibility to keep all medical records for the animal in order and up to date.

In the event that I cannot continue to foster the animal I will give HPR 90 days advance notice.

I agree to advise HPR if the animal is sick or gets sick while in foster care at once!

I understand that medical for the animal needs to be approved by HPR beforehand, unless of course is a life threatening emergency.

I agree by electronically signing this application, to let Hurricane Pets Rescue enter my home at any time to check on the care and well being of the animals.

In the event that Hurricane Pets suspects neglect or abuse, or for no specific reason, YOU (the foster) agrees by electronically signing this application to let HPR retrieve the animal or animals in my care at once.

And YOU (the foster) will make every effort to cooperate with the rescue effort for these animals

Applicant Signature:Sign Electronically.

DateToday' Date

Hurricane Pet RepresentativeCase Manager

Approved / Denied

Approval or Denial Date