Name
Street Address
City
State
Zip Code
Email
Phone
What is your preferred method of contact?
Phone Call
Text Message
Email
Are you 18 years or older?
If "Other" please explain
If you Rent, what is the pet policy?
Landlord or Rental Agency Name
Contact Phone #
How many adults live in your home?
How many children?
Age(s) of children?
Does anyone in your home have pet allergies? Please describe.
Please list any other animals in your residence with these details - Animal Type/Breed, Age, Gender, & if Spayed/Neutered
If you have other pets, are their vaccinations current?
Yes
No
I have no other pets
Please provide the Clinic name, Address, and Contact info for your Veterinarian:
Are you willing to foster pets recovering from injuries?
Are you willing to foster pets with health conditions requiring medication?
What other organization(s) have you previously assisted with fostering? Please list names and addresses.
Have you ever surrendered animals to a shelter in the past?
Who will be primarily responsible for the care of the fostered animal(s)?
How many hours will the fostered animal be left alone each day?
Where will the fostered animals be kept at night?
Do you have a fenced yard?
If yes, what type of fence?
Wood - Spicket
Wood - Rail
Wood - Privacy
Vinyl
Composite
Chainlink
Metal - Rail
Metal - Wrought Iron
If yes, how high is your fence?
If no, what is your plan for containment and exercise?
My ideal foster animal is: (please describe)
Foster Volunteer Release, Wavier, and Indemnification
In consideration of being permitted to foster volunteer with K9 Hope Broker, I, the undersigned, voluntarily agree to the following:
1. I acknowledge that I am 18 years or older.
2. I agree to conduct myself in a courteous and professional manner as a foster volunteer and representative of K9 Hope Broker, and I will treat all the animals with the highest respect.
3. I agree to follow all K9 Hope Broker policies and procedures and abide by all the instructions from the staff.
4. I agree that my foster volunteering services to K9 Hope Broker are performed on a volunteer basis without pay, without medical or worker’s compensation insurance and without compensation of any kind and all my foster volunteering service hours are performed at my own risk. I agree that it is my responsibility to act in such a manner as to be responsible for my own safety while foster volunteering.
5. I agree that all food and supplies for the fostered pets are my responsibility as part of the agreed, volunteer care for the pet(s). 6. I authorize K9 Hope Broker Staff to contact the emergency contact on this application and seek emergency medical care in case of my accident, illness or injury.
7. I have disclosed all relevant medical conditions on this application and will advise K9 Hope Broker of any changes. I acknowledge that K9 Hope Broker strongly recommends that I keep current with tetanus and rabies vaccines and to advise my doctor that I may be handling animals. I agree that all inoculations, medical care and medications are my own responsibility, and I release K9 Hope Broker from all responsibility with respect to the same.
8. I give K9 Hope Broker exclusive right to use, publish or reproduce any photographs, drawings, writings and or copyrightable material produced of me or by me as a foster volunteer.
9. I agree to keep confidential indefinitely all K9 Hope Broker records and information regarding previous and new owners and K9 Hope Broker Animal records.
10. I agree to immediately contact K9 Hope Broker if there are any emergencies, injuries, or fatalities associated with the foster pet(s) I am managing within an hour of the incident occurring or discovery of the incident.
11. I agree that K9 Hope Broker may refuse or terminate my participation in its foster volunteer program at any time without notice, at which time I will return any currently fostered pet(s) back to K9 Hope Broker, as the owner/Agent of the owner.
12. To protect outside pets from contracting any potential foster disease, and to prevent the foster pets from developing illness from outside pets, I certify that all my personal pets in my home are current on their rabies, distemper, Bordetella and parvo vaccines.
13. I acknowledge the risks and dangers inherent in handling animals and in otherwise foster volunteering with K9 Hope Broker and I freely assume and fully accept these risks. I hereby waive any rights to cause of action or future cause of action that I may have against K9 Hope Broker and its directors, officers, agents, employees, servants, representatives and assigns (collectively, K9 Hope Broker and its Representatives), and release, discharge, indemnify and hold harmless K9 Hope Broker and its representatives from and against all claims, actions, costs, expenses and demands, in respect of the following, not limited to death, injury, loss or damage to person or property, arising out of in connection with my foster volunteering, howsoever caused, even if such loss or injury is caused by the negligence or default of K9 Hope Broker and its Representatives.
14. I agree to this waiver, indemnity, and consent on behalf of myself, my heirs, executors, and assigns.
Full Name (Digital Signature)
Date
Emergency Contact: Name, Email & Phone
Please attach a photo of your DL or Photo ID
Submit