FOSTER APPLICATION

Your Name (First, middle, last):(Required)

Your Preferred Name:

Your Date of Birth (MM/DD/YYYY): NOTE - YOU MUST BE 18+ YEARS OLD TO FOSTER!(Required)

Your Address (Street):(Required)

IF YOU RENT, YOU WILL NEED TO OBTAIN LANDLORD/HOMEOWNER PERMISSION PRIOR TO US PLACING AN ANIMAL IN YOUR CARE.

Your Address (City and Zip Code):(Required)

Your County of Residence (for example, Franklin County, Licking County, etc.):(Required)

Your E-mail:(Required)

Your Phone Number (XXX-XXX-XXXX):(Required)

How did you hear about our foster program?(Required)

Have you ever fostered before? If yes, please give a brief description of your foster experience.(Required)

What type of animals are you most interested in fostering (check all that apply)?(Required)

What length of fostering term are you most interested in?(Required)

Short term (less than 2 weeks)

Typical term (2-8 weeks)

Long term (8+ weeks)

PLEASE NOTE: A length of stay for a particular animal is NEVER guaranteed due to the health of the animal and available space in the shelter.

Please list the first AND last names of all the adults (18 years and older) who live in the home:(Required)

Please list the number of children who live in the home (or who visit frequently) and include their ages (names are NOT needed):(Required)

Please list all animals currently living in the home. Include: 1) Name 2) Age 3) Species 4) Breed and 5) Sex:(Required)

Are your pets up to date on their vaccinations?(Required)

Yes

N/A - I do not have any pets.

(NOTE: We will require you to provide us with vet records for all cats and dogs in your home.)

Are your pets spayed/neutered?(Required)

Yes

N/A - I do not have any pets.

If any of your pets are not spayed/neutered, please provide a brief explanation (type "N/A" if you do not have any pets):(Required)

Please describe your foster set-up: Where will the animal spend its day? Where will the animal sleep?(Required)

Do you understand that if you want to end fostering early, you may have to wait until space becomes available at the shelter?(Required)

Yes

NOTE: It can take days to weeks for space to become available at the shelter.

Do you understand that you may receive an animal who has an undetected contagious medical condition and you &/or your personal pets may contract illlnesses passed on from the foster animal?(Required)

Yes

By typing your full legal name in the space below, you are indicating that you have read the information below AND that the application is filled out truthfully and completely.(Required)

LCHS provides all routine and emergency veterinary care through our designated veterinarians. FOSTER PETS ARE NOT TO BE TREATED BY UNAUTHORIZED VETERINARIANS UNLESS PRE-APPROVED BY YOUR CONTACT PERSON AT LICKING COUNTY HUMANE. EXPENSES RESULTING FROM UNAUTHORIZED VETERINARY CARE WILL BE THE RESPONSIBILITY OF THE FOSTER PARENT. ANY FALSIFIED INFORMATION OR SIGNIFICANT OMISSIONS ON THIS APPLICATION MAY DISQUALIFY AN APPLICANT FROM FURTHER CONSIDERATION FOR FOSTERING A LCHS ANIMAL.

Today's Date (MM/DD/YYYY)(Required)

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