Foster Application Foster Application Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Date of Birth* MM slash DD slash YYYY Home Telephone Alternate Telephone Work Telephone Email* Is there a specific animal you are interested in fostering?*YesNoIf 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 What type of home do you have?*HouseDuplexApartmentMobile HomeCondo/TownhousePlease list any other persons residing in their home, their relation to you, and their ages.*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*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 signatureDate MM slash DD slash YYYY
