EmailMe Form - Foster Application

I confirm that all information provided on this application is true and correct. I understand that by giving false information, I will be ineligible to foster any animal, now or in the future, from La Plata County Humane Society.

EmailMeForm

Name: *
First Last
Email: *
Street Address: *

Street Address City State / Province / Region Postal / Zip Code
Primary Phone: *
### - ### - ####
Secondary Phone: *
### - ### - ####
DL# *
Please explain in a couple sentences why you would like to foster for LPCHS.
Are you at least 21 years old? *
Yes
No
Do you have a fenced yard? *
Yes
No
Are there children under 18 in the home? *
Yes
No
If so, please list ages of all children in the home:
Do you have dogs? *
Yes
No
Do you have cats? *
Yes
No
Are you currently fostering for any other organizations? *
Yes
No
Can the space where fosters will be kept be easily disinfected with bleach? *
Yes
No
Can fosters easily be isolated from other pets in the home? *
Yes
No
Do you smoke in your home? *
Yes
No
Do you rent or own?

If you rent, please provide your landlord's name and phone number. *
Own
Rent
Landlord's name
Landlord's phone:
### - ### - ####
Current type of housing: *
House
Condo or Apartment
Mobile Home
Other
What pet(s) would you be willing to foster? *
Puppies with mom
Orphaned puppies requiring bottle feeding
Puppies that do not require bottle feeding
Adult dog, who needs socialization and behavior work
Kittens with mom
Orphaned kittens requiring bottle feeding
Kittens that do not require bottle feeding
Adult cat who needs socialization
Animals who need housing during an emergency evacuation
Foster field trip program
Adult dog buddy program
Do you have reliable transportation? *
Yes
No
Are you willing to have a LPCHS staff member to visit your home annually? *
Yes
No
Is anyone in your home allergic to animals? *
Yes
No
If so, explain *
Have you ever had a dog impounded by Animal Control? *
Yes
No
Have you ever surrendered an animal? *
Yes
No
Have any of your animals ever been poisoned? *
Yes
No
Have any of your animals been hit by a car at your current address? *
Yes
No
Have you read the Foster Care Brochure? If not, please do so. *
Yes
No
Please describe the space where fosters will be kept when you are home and at bedtime. *
Please describe the space where fosters will be kept when you are not home. *
Beyond basic care, how many hours a day will you spend interacting/socializing your foster? *
Less than 1 hour
1-2 hours
3-4 hours
5-8 hours
Over 8 hours
How many hours a day will your foster be home alone? *
Less than 1 hour
1-2 hours
3-4 hours
5-8 hours
Over 8 hours
Please provide this information for the animals who are currently in your home.

Breed Age Sex Are they fixed? Vaccines Current? Y/N Where do they spend most of their time?
Please provide this information for any animals you have had in the last 5 years.

Breed Age Sex Are they fixed? What happened to this pet?
Do you agree to abide by all applicable city, county and state ordinances relating to housing and control of animals? *
Yes
No
I confirm that all information provided on this application is true and correct. I understand that by giving false information, I will be ineligible to foster any animal, now or in the future, from La Plata County Humane Society.
Signature:

If using a computer or laptop, use mouse to sign your signature. If using tablet, sign with finger. *
Clear
Date: *
MM / DD / YYYY

Are they fixed?

Vaccines Current? Y/N

Where do they spend most of their time?