FosterApplication

Friday, 24 May 2013

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H.E.A.L, Inc.

Helping Every Animal Live

Filling out this application to be a Foster Caregiver for H.E.A.L, Inc. does not guarantee approval as a Foster Caregiver for H.E.AL, Inc. We reserve the right to reject an applicant based on the information obtained on the application, through a reference check, or home visit check. Our primary goal is for the welfare, health, and safety of our companion animals who we have rescued and saved from euthanasia. These animals are part of our Family and it is our intention to ensure that they have the best care and are loved for the remainder of their natural lives.

Applicant's name: *

Physical Address: *

Mailing address (if different from above):

E-mail Address: *

Home Phone Number: *

Cell Phone:

Work Phone:

Preferred Phone Number for contacting you: *

Best Time to Call: *

Employer: *

Employer's Phone Number: *

Animal Name/ ID Number: *

Breed: *

Color/ Markings: *

Gender: *

Approximate Age: *

ATTENTION RENTERS: A copy of your landlord's complete pet policy including specification of any breed or weight restrictions if present, must be attached. H.E.A.L, Inc. is not responsible for any additional monthly pet fees required by your lease agreement or pet policy. Application will not be processed without this documentation.

Please list all persons living in your household (name, age, sex, relationship to Applicant): *

Do you own or rent your home?: *

If you rent, do you have your landlord's permission to keep a rescued animal?:

Landlord's Name:

Landlord's Phone:

How many pets are allowed according to your rental agreement?:

Attach pet policy if you are renting:

Approximate size of your yard: *

Type of fence: *

Height of fence: *

If no fence, describe how you will exercise the animal safely: *

Does your city or county have a limit of pets per household?: Yes
No
*

If yes, what is the limit?:

What is the number of your Local Animal Control: *

Is anyone in your household allergic to dogs or cats?: Yes
No
*

Please specify which animal the person or persons is allergic to in your household:

Do all members of your household agree to have a rescue animal in your home?: Yes
No
*

Please list all household pets that have resided in your home in the last 5 years: (list the type of breed, gender, age, if they where spayed, or neutered, up to date on all their vaccinations, on monthly HW, flea/tick preventatives, and tell us where your pet is now (please explain in detail): *

How many hours a day will your rescue animal spend without human companionship?: *

Where will your rescue animal stay when you are not home?: *

Where will your rescue animal be when you are home?: *

Where will your rescue animal sleep at night?: *

Has any dog residing in your home ever bitten anyone (including you) or shown any signs of aggression toward another dog or person? If yes, give the name of the dog and please explain the situation and the outcome: *

Do you know how to break up a dog fight?: Yes
No
*

Please explain how to break up a dog fight: *

Have you ever surrendered an animal into a shelter or had an animal euthanized? Yes or No and please explain: *

Have you ever adopted an animal from another rescue group or shelter? Yes or No/ If yes, please provide the contact information for whom you adopted: *

Are you currently fostering for another rescue group, shelter or rescue?: Yes
No
*

If yes, please provide the contact information for whom you are fostering:

Please describe your specific experience with basic training: *

Please describe your specific experience with modifying a behavior problem: *

Please describe your specific experience with caring for a pregnant female: *

Please describe your specific experience with caring for newborns: *

Please describe your specific experience with raising puppies, kittens, bunnies until ready to be placed in new homes: *

Please describe your specific experience with caring for an elderly animal, or one with a chronic health problem: *

Socialization (exposure to other pets, strangers, children, and various experiences): *

Please describe your specific experience with other training (be specific): *

Are you comfortable with animals you do not know?: Yes
No
*

Please explain why you are or are not comfortable around animals you do not know: *

Please describe all rescue-related experience you have had, if any: *

What circumstances, if any, would cause you to return an adopted animal in your care?: *

How much time will you spend interacting with an adopted animal per day?: *

Describe the general activity and noise level of the household: *

What activities will you participate in with your adopted animal?: Daily walks
Lap time
Dog park
Hikes
Basic Training
Other
*

If you chose other what would this be?:

Temperament and behavior problems may emerge after an animal enters a new environment. Are you prepared to handle behavioral issues with assistance and guidance from H.E.A.L, Inc.?: Yes
No
*

Foster animals must sometimes be humanely euthanized for severe, irreversible, or untreatable behavioral or health issues. Do you understand and accpet this?: Yes
No
*

NOTE: A home visit check is required prior to your approval as foster caregiver for H.E.A.L, Inc.

NOTE: H.E.A.L, Inc. will pay for and supply the following veterinary care/items:

Monthly heartworm preventatives medication
Monthly flea/tick preventative medication
Emergency care for emergency injury or illness; H.E.A.L, Inc. MUST be notified PRIOR to treatment and MUST be fully informed of the medical situation and probable outcome from treatment options by the veterinarian who is to treat the foster animal. H.E.A.L, Inc. retains the right to make final decisions as to treatment based on information and recommendation by the veterinarian.
Routine veterinary care MUST be approved PRIOR to office visit to qualify for payment by H.E.A.L, Inc.

Are there other ways in which you would like to help or rescue efforts? Mark all that apply and add any information you feel is relevant. Would you assist with any of the following:

Assist H.E.A.L, Inc, by taking part in the following: Transport Animals
Assist with screening foster or adoption applications (example, checking references)
Photograph animals for H.E.A.L, Inc.
Evaluate an animal for rescue
Perform home checks
Other
*

If you chose other what would this be?:

We require a veterinary reference; Please provide up to 3 references of people with whom you have worked in rescue, if available. This may include shelters, other rescues, or animal transporters. Not having references of this nature will NOT disqualify you as an adopter with H.E.A.L, Inc.

Veterinarian's full name and name of practice: *

Phone Number: *

Vet's full address: *

Personal reference 1- full name: *

Phone Number: *

How does this person know you?: *

Personal reference 2- full name: *

Phone Number: *

How does this person know you?: *

Personal reference 3- full name: *

Phone Number: *

How does this person know you?: *

Please provide up to 3 references of people with whom you have worked in rescue, if available. This may include shelters, other rescue, or animal transporters. Not having references of this nature will NOT disqualify you as an adopter with H.E.A.L, Inc.

Rescue reference 1- full name:

Phone Number:

How does this person know you?:

Rescue reference 2- full name:

Phone Number:

How does this person know you?

Rescue reference 3- full name:

Phone Number:

How does this person know you?:

Please provide any other information you feel would help us evaluate your application:

RELEASE OF LIABILITY AND INDEMNIFICATION

The foster caregiver understands that all work done with adopting agent and/or its rescue animals is at his/her own risk, and hereby releases adopting agent, its officers, volunteers, agents, employees, contractors and representatives from any liability of any kind whatsoever arising from his/her voluntary foster of an adopting agent animal and/or from any claims relating to fostering, adoption, ownership or possession of the animal. The foster caregiver also agrees to indemnify and hold harmless adopting agent, its officers, volunteers, agents, employees, contractors and representatives from any and all losses, fines, claims or damages, including reasonable attorneys’ fees, arising out of or relating to the animal or his/her voluntary fostering of said animal, including any claims for injury or damage to persons or property caused by the animal.

The undersigned applicant has been advised of these facts, has read and understands all content of this application, and agrees to all conditions herein. Applicant certifies that he/she is above the age of 21 years old and all of the above information given is true and complete. Applicant agrees to follow all the Rules and Procedures of H.E.A.L, Inc. H.E.A.L, Inc. reserves the right to refuse any applicant without explanation.

Date: *

Signature: *

Full Name:

Thank you for filling out a foster apllication we will be in touch with you as soon as possible.

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