Foster Application

Personal Information

Name: *

Date of Birth:

Address:

City:

State:

Zip:

Cell Phone: *

Work Phone:

Email: *

Housing

Do you own or rent?

If you rent, are animals allowed?

If there are restrictions on animals, explain:

Household

Number of children:

Ages:

Do you have a yard?

Is the yard completely fenced?

Circle the option that describes your normal day:

Home all day

Out part-time

Gone 7-10 hrs daily

Current Pets

Dogs:

Cats:

Other:

Name of your veterinarian:

Are your pets:

Current on vaccinations?

All spayed/neutered?

If not spayed/neutered, explain:

What type of animal(s) would you like to foster?

Young unweaned kittens without a mom

Young unweaned kittens with a mom

Weaned kittens

Adult cats

Young unweaned puppies without a mom

Young unweaned puppies with a mom

Weaned puppies

Adult dogs

Pocket pets (ferret, hamster, gerbil, etc.)

Rabbits

Sick or injured pets

Other (specify):

Are you willing to foster more than one animal at a time?

Yes

No

Any foster pet you take needs to get along with:

Dogs

Cats

Kids

Where will the foster pet be kept? (check all that apply)

Loose indoors

Basement

Garage

Closed in a room

Fenced yard

Pen

Loose outdoors

Tied outside

Crate or carrier

Experience

Have you cared for young, unweaned puppies or kittens before?

Yes

No

If yes, explain:

Have you ever given medication to sick animals before?

Yes

No

Are you willing to provide food and litter at your own cost for foster pets?

Yes

No

Have you ever fostered an animal before?

Yes

No

If yes, what organization did you foster for?

Foster Agreement

* I make the above statements and voluntarily enter into this agreement to provide a temporary home as a foster caregiver to any animals Kiya Koda Humane Society may temporarily place in my care. I agree to all terms including home inspection access, providing veterinary care as authorized, preventing breeding, returning the animal upon request, and all other provisions of the foster agreement. I have read this application and agreement in its entirety, and I agree that all statements are truthful, under penalty and perjury under the laws of the State of Iowa.

Printed Name: *

Date:

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