Foster Application

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

Date of Birth*

Home Telephone

Alternate Telephone

Work Telephone

Email*

Is there a specific animal you are interested in fostering?*

If yes, please list the animal's name

What kind of animal(s) would you prefer to foster? (Check all that apply)

Kittens
Adult cats
Puppies
Adult dogs
Small animals (rabbits, guinea pigs, etc.)

What types of foster needs are you interested in helping with? (Check all that apply)*

Underage animals (kittens, puppies, and small animals under 8 weeks of age)
Animals recovering from surgery/undergoing short term medical treatment
Animals undergoing long term medical treatment (permanent foster)
Animals in need of hospice care
Animals with behavior and/or training needs
Animals that are timid or shy and need socialization

Have you fostered for the Humane Society of Harrisburg Area before?*

If you fostered with HSHA before, what year?

Have you fostered for any other organization?*

If you have fostered with another organization, what organization?

What type of home do you have?*

Do you rent or own your home?*

Rent
Own

If you rent please provide your Landlord's name and phone number below*

If you rent, does your landlord/property management company have any breed restrictions for dogs?*

If you rent, please upload a copy of your pet agreement.

How long have you lived at this address?*

Please list any other persons residing in their home, their relation to you, and their ages.*

Does anyone in your household have pet allergies?*

If someone in your household has pet allergies, are they on medical for it?

Please list any animals currently living in your home. Include their name, breed/species, if they are current on shots, if they are spay/neutered, and their age*

Are all dogs in the home licensed for the current year?*

Are your pets housed...*

If other, please explain

Please list the name of your current Veterinarian or the Veterinary Clinic you use for your current and/or previous pets and their phone number*

Please upload the most recent vaccination records for all pets currently on your household

Drop files here or

Have you or anyone in your household ever been cited for an animal-related offense?

If yes, please explain

Will you be able to keep fostered pets separated from your own pets if necessary?*

If yes, please explain

I understand that upon completion of this foster animal’s goals, he/she shall be returned to the Humane Society of Harrisburg Area, Inc. (HSHA) to be placed up for adoption through the established adoption process with the final approval of acceptable adopters made by HSHA staff.

I further understand and accept that some animals will not survive or may have to be euthanized and that this decision will be made by HSHA.

I understand that, upon request, HSHA may send a representative to inspect the condition of a foster animal and where it is being kept.

Through my signature, I hereby grant HSHA permission to verify the information provided in this document. I have answered the questions contained herein truthfully and completely. I understand that although HSHA takes reasonable care to screen animals for foster care replacement, it makes no guarantee relating to the animals’ health, behavior, or actions. I understand that I receive foster care animals at my own risk and can reject or return any animals for which HSHA has asked me to provide care. I indemnify and hold HSHA free and harmless from all liability arising our of any and all claims, demands, losses, damages, action, judgment of every kind and description which may occur to or be suffered by me, members of my household, or any third parties by reason of activities arising out of this agreement.

Electronic Signature

Type your name here to represent your electronic signature

Date

Foster Application

Foster Application

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