Disaster Relief Foster Parent - Rescue Group, Shelter Screening Application
We are Paw Obligated to Check You Out!
Today's Date
Name of pet you will be fostering (if known)
Will you allow a Hurricane Pets representative to do a home visit to your home or rescue facility?
select one
Yes
No
Can you commit to fostering a pet for at least one year?
select one
Yes
No
If the above answer is no, for how long can you commit to foster the pet?
something more
Your Name
full name
Date of birth
(Over 18)
Address
City
State
Zip Code
Email
a valid email
Home Phone #
ex: (555) 555-5555
Mobile Phone #
ex. (555) 555-5555
Employed
select one
Yes
No
Retired
Self Employed
Employer Address
Type of Residence
Select if you rent or if you own and type of residence.
Rent
Own
Live with parents
Live with roommates
Apartment
House
Condo
Townhome
Mobile Home
Private shelter
Rescue Group (Foster Homes)
Rescue Group Facility
Sanctuary
other
How long have you lived at your present address? Or if are a rescue group, shelter or sanctuary how long you been in business?
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
Yes
No
Landlord Name
ONLY IF YOU RENT
Landlord Tel. #
(555) 555-5555
Landlord E-Mail
Landlord permission to have a pet
select one
Yes
No
Landlord’s Initials for Consent to have a pet
Landlord Signature
Type and Number of pets allowed
Rescue Groups, shelters and sanctuaries. Are you a registered 501(C)(3) organization?
Rescue Groups, shelters and sanctuaries, please describe your adoption policies:
Rescue Groups, shelters and sanctuaries, please specify number of pets that you can take into your facility.
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
Yes
No
Will the pet be:
select one
Inside
Outside
Both
Do all members of your household agree to you fostering a pet?
Yes
No
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?
full name
Do you or anyone in household smokes?
select one
Yes
No
If the answer above is "Yes", do you smoke:
select one
inside
outside
indoors and outdoors
Do you have a pet door in your home?
select one
Yes
No
Will you commit to take the pet to the vet when needed?
select one
Yes
No
If you foster a dog, where would the dog sleep?
select one
Indoors
Outdoors
Other
If "Other" above please explain:
something more
Which word or words best describes your home/lifestyle?
select all that applies
Laidback
High-energy
Quiet/calm
Bustling
Noisy
Busy
Not home much
Home all the time
How Many animals do you have in your home, rescue facility or shelter presently?
INFORMATION ON YOUR CURRENT & PREVIOUS PETS.
List all current Pets Below:
Pet # 1: Name
Species
ex. Dog, Cat, Rabbit, etc.
Age & Years owned or fostered?
Pet # 2: Name
Species
ex. Dog, Cat, Rabbit, etc.
Age & Years owned or fostered?
Pet # 3: Name
Species
ex. Dog, Cat, Rabbit, etc.
Age & Years owned or fostered?
Are all the listed above pets in the household rescue facility or shelter spay and neutered?
select one
Yes
No
I the answer above is "NO" please explain:
Rescue Groups, shelters and sanctuaries. What is your spay and neuter policy?
List them here.
Are all pets in your rescue, shelter, sanctuary or household tested for FELV and FIV?
select one
Yes
No
When was the last time the cats where tested for FELV and FELV:
select one
A month ago
3 months ago
Over a year ago
Over 5 years ago
Please check FELV-FIV test results:
select one
Positive
Negative
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:
If there dogs in your household are your dogs tested for Heartworm :
select one
Yes
No
Heartworm test results?
select one
Positive
Negative
Are all dog in your household or at your facility on Heartworm preventive?
select one
Yes
No
Are all dogs and or cats presently in your home, rescue or shelter treated with monthly flea medications?
select one
Yes
No
What flea medication products do you use?
How often do you deworm?
VETERINARIAN INFORMATION
Veterinarian’s Name:and Last Name:
Address:
City:
State
Zip Code:
Phone #:
ex. (555) 555-5555
Fax #:
ex. (555) 555-5555
Email
a 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 get married or re-marry 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 it:
select one
Yes
No
In a DISASTER (hurricane, tornado, earthquake, etc.), would you leave your pet alone at home if you had to go to a shelter?\]
select one
Yes
No
Please explain what would you do with the pet, in the event of a Mother Nature or Man made disaster ?
Please provide a personal reference not related to you below.
Name and Last Name:
full name
Telephone #:
ex. (555) 555-5555
Email
a valid email
WE RESERVE THE RIGHT TO REFUSE ANY APPLICANT - PLEASE READ INITIAL AND SIGN BELOW:
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 IRS letter of determination.
File
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What is your preference for fostering
select all that applies
Puppies
Adult Dogs:
Cats
Kittens
Senior Cat
Senior Dogs
Special 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 youHave experience with neonatal pets (new borns)
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:
What do you think of this statement: Any home is better than no home at all, or better than being euthanized at a shelter?
Please Note: 1- 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.
2- 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.
Applicant Signature:
Sign Electronically.
Date
Today' Date
Hurricane Pet Representative
Case Manager
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 YOU (the foster) agrees by electronically signing this application to let HPR retrieve the animal or animals in my care at once.An will make every effort to cooperate with rescue effort for these animals
FOR OFFICE USE ONLY
Approved / Denied
Approval or Denial Date
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