Humane Society of Stanislaus County
Foster Home Application
Instructions: This application can be completed on-line or you may print the application and fill in by hand. Mail completed applications to: HSSC, 1620 N. Carpenter Road, Suite D-57B, Modesto, CA 95351
Date of Application
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TYPE OF ANIMALS I WISH TO FOSTER (check all that apply):
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Dog
Cat
Puppies
Kittens
Large Animals (Horses, Goats, etc)
LENGTH OF TIME I AM AVAILABLE TO FOSTER (check all that apply):
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Emergency (1-3 days)
Short Term (Up to 1 month)
Long Term (Up to 4 months)
Are you interested in fostering animals with special medical needs and are you willing to administer medication/medical treatment if needed?
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YES
NO
Are you interested in fostering animals with special medical needs and are you willing to administer medication/medical treatment if needed?
*
YES
NO
Are you interested in fostering animals that are rescued during a natural disaster in the county?
*
YES
NO
Personal Information
Name
*
Address (This must also be the address in which the animal will reside.)
*
City, State, Zip
*
Phone Number
*
Email
Are you 18 years of age or older?
*
YES
NO
Are you in good health?
*
YES
NO
Date of last tetanus shot:
*
Do you have any physical, medical or psychological limitations that would affect your ability to provide foster care (e.g. back injury, allergies, pregnancy, heart condition)?
*
YES
NO
Have you ever been convicted of a misdemeanor or felony?
*
YES
NO
If Yes, explain:
If you wish to foster dogs, are you knowledgeable about dog training techniques?
*
YES
NO
Describe your experience working with animals and any previous experience you have had fostering animals:
*
Do you have pets at home?
*
YES
NO
NOTE: We require that all pets at your home are up-to-date on their vaccinations, including Bordetella for dogs, that dogs are on heartworm preventative, and that all pets are in good health to reduce the possibility of you transmitting disease between the HSSC animals and your own animals. We also generally require that all pets at your home are altered; however, exceptions can be made on a case by case basis. All dogs residing at the home must be licensed by the county. If any of your pets are aggressive to other animals, we may require special arrangements be made for the fostered pet.
I can transport fostered dogs/cats/small animals to (check all that apply):
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Veterinarian
Adoption Events
HSSC Office
I generally will not be able to transport fostered animals
Foster Home Information
TYPE (check one)
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Own House
Rent House
Rent Appartment
Mobile Home
IF YOU RENT - Name of Landlord:
Daytime Phone Number
Evening Phone Number
Does your rental agreement allow pets?
YES
NO
If Yes, how many? NOTE: We will need to obtain phone or written permission from your landlord before approving the fostering of a pet.
WHERE WILL FOSTER PET BE KEPT?
*
Indoors ONLY
Outdoors ONLY
Indoors AND outdoors
Approximate Size of Yard
Is it fully enclosed with a fence?
*
YES
NO
If not fully enclosed, is it partially enclosed with a secured fenced area where the pet will be kept?
*
YES
NO
Type of Fence (check all that apply):
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Wood
Wire
Other
Height of Fence:
Are gates secure?
*
YES
NO
Are there any areas in or under the fence that need repair to ensure the security of the foster pet?
*
YES
NO
Describe the shelter for foster pet:
*
Are there other adults living in the home?
*
YES
NO
If Yes, Number:
Are there children living in the home?
*
YES
NO
If Yes, Number & Ages:
Who will be primarily responsible for the care of the foster pet?
*
Who will care for the foster pet when this person is away from the residence?
*
How many hours each day would the fostered animal(s) be left alone?
*
Emergency Contact Information
Name
*
Relationship
*
Daytime Phone Number
*
Evening Phone Number
*
Submit Form
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