Foster Care Application & Agreement

THE HUMANE SOCIETY

2 JACKSON ST

BINGHAMTON, NY 13903

Phone (607) 724-3709

Foster Care Application & Agreement

Name: ______

Name(s) of Spouse/Partner/Roommates: ______

Home Phone: ______Cell Phone: ______

Email Address: ______

Address: ______

City: ______State:______Zip: ______

Type of Dwelling: House Condo Apartment Trailer Other (Circle one)

Do you rent? ______Own? ______

If you rent, we must contact your landlord to verify that he or she allows pets on the premises before your application can be considered. Please provide his/her information:

Landlord’s Name: ______Phone #: ______

How long have you been at your current address? ______

YourOccupation: ______

Employer: ______Work Hours: ______

Spouse/Partner/Roommates Occupation: ______

Employer: ______Work Hours: ______

People in Household:

# ofAdults: ______# of Children (Please list ages)______

If children are present in the home, have they been exposed to animals before? YES / NO (Circle one)

What kind? ______

______

Does anyone in the household have pet allergies? YES / NO (Circle one)

To what? ______

______

Which members of your family will feed and care for the foster animal(s)? ______

______

Tell us about yourself & your pets:

Do you currently have any pets? YES / NO (Circle one)

If so, please list their names, species, breed, gender, and if they are spayed/neutered: ______

______

______

______

Have you had additional pets in the past? If so, please list their species, breed, and reason they no longer live with you. If previous pets have passed away, please indicate the cause. ______

______

______

______

Are your current pets up to date on their vaccinations? YES / NO (Circle one)

Are all of your pets currently on flea/tick control? YES / NO (Circle one)

Which brands do you use? ______

Who is your veterinarian? ______Phone #: ______

May we contact your veterinarian regarding your foster care application? YES / NO (Circle one)

Are you familiar with any behavioral training methods? YES / NO (Circle one)

Please explain: ______

______

Will you train/seek training for the foster animal(s) in your care if necessary? YES / NO (Circle one)

Tell us about your home:

Is there an adult at home during the day? ______

How many hours a day will the animal(s) be left alone? ______

Where will your foster animal(s) be kept? ______

______

What outside space is available to the foster animal(s)? ______

______

How will the foster animal(s) be exercised? ______

______

______

Do you have a fenced in yard? If so, please provide approximate measurements, height, and type of fencing. Please note if the fencing is full or partial. ______

______

______

Please provide three references that can attest to your suitability as a pet caretaker:

Name: ______

Phone #: ______

Relationship to Applicant: ______

Years Known: ______

Name: ______

Phone #: ______

Relationship to Applicant: ______

Years Known: ______

Name: ______

Phone #: ______

Relationship to Applicant: ______

Years Known: ______

Foster Care Agreement

The parties hereto agree as follows: The Foster Caretaker signing below acknowledges receipt from The Humane Society, 2 Jackson Street, Binghamton NY 13903, of the animal(s) described below for foster care: and in accepting said animal(s), and in consideration for being entrusted with the care, custody, and possession of the animal(s), agrees to be bound by the covenants and conditions listed below.

Animal(s) Received:

ID # and Name: ______

Date: ______

Breed/Sex/Age: ______

Medical Condition: ______

The parties agree that:

a)The Foster Caretaker shall provide the animal(s) with good care, including, but not limited to food, water, shelter, grooming, training, and medication when required.

b)As between the Foster Caretaker and The Humane Society, the animal(s) shall remain the sole property of The Humane Society. The Foster Caretaker understands that the animal(s) remain the property of The Humane Society at all times. In the event that the Foster Caretaker wishes to become the owner of the animal(s), he/she must apply for adoption following normal procedures. The Foster Caretaker further understands that fostering an animal does not necessarily guarantee approval for adoption.

c)The animal(s) shall be returned to The Humane Society upon request by The Humane Society, or if the Foster Caretaker is no longer able to adequately care for the animal(s), or if the Foster Caretaker is relocating outside of the Broome County Area.

d)Agents of The Humane Society will be allowed to inspect the premises in which the animal(s) will be maintained or are maintained, from time to time, for the purpose of determining the suitability of those premises for the care and maintenance of the animal(s).

e)The Foster Caretaker understands and acknowledges that she/he does not have any right or authority to keep the foster animal(s) or to place foster animal(s) in other homes or places with other individuals unless permission is given in writing by The Humane Society personnel.

f)The Foster Caretaker understands and acknowledges that she/he is responsible for all expenses incurred as a result of fostering an animal. The sole exception to this is that The Humane Society will provide no charge, initial vaccinations and medication for minor existing ailments. The Foster Caretaker will not take the animal(s) to a veterinarian without first contacting The Humane Society and obtaining permission and instruction. The Foster Caretaker further understands that if the animal(s) is taken to a veterinarian without obtaining permission, he/she is fully responsible for any costs incurred.

g)The Foster Caretaker agrees that should the animal(s) require extensive medical treatment The Humane Society may request immediate return of the animal(s) and may euthanize the animal(s) for humane reasons.

h)In the unfortunate event that the animal(s) becomes so ill during foster care as to warrant humane euthanasia, the Foster Caretaker will notify The Humane Society before having the animal(s) euthanized and supply The Humane Society with medical documentation from his/her veterinarian verifying euthanasia and the reasons for it.

i)The Foster Caretaker agrees to defend, indemnify, and hold The Humane Society harmless from any direct or remote and consequential damages arising out of this foster care program.

j)The Foster Caretaker understands that the foster animal(s) may have undiagnosed illness that could be transmitted to other animals or persons in their household. The Foster Caretaker also agrees to hold The Humane Society harmless for the costs of any medical treatment of their non-fostered animal or any persons in their household that may incur during the foster contract.

k)The Foster Caretaker will be the only person to handle the animal outside of the home.

The Foster Caretaker agrees to return said animal to The Humane Society no later than ______.

*Subject to change if authorized by The Humane Society Personnel

This contract represents the entire agreement between the parties and any modifications will be made in writing and signed by both the Foster Caretaker and a representative of The Humane Society.

Foster Caretaker:

Executed this ______day of ______

Signed: ______

The Humane Society:

Executed this ______day of ______

Signed: ______