Applicant’s Full Name
Phone Number
Street Address
City
State
Zip Code
Driver’s License #
State Issued
Alternate Phone #
Employer
Employer Phone
Other Household Members
Do you rent or own your home? RentOwn
Landlord’s Name (if renting)
Landlord Phone
Type of Dwelling ApartmentCondoSingle FamilyTrailer
Is the yard fenced? YesNo
Do you have other pets of your own? YesNo
If yes, describe your pets
Are your personal pets up to date with required vaccinations? YesNo
Do your pets live indoors? YesNo
Are your pets spayed/neutered? YesNo
Do your pets receive flea/tick prevention? YesNo
Do your pets receive heartworm prevention? YesNo
Veterinarian’s Name
Veterinarian Phone
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Foster Care Provider Guidelines Agreement
I understand I am the custodian of a Columbus Humane Society animal.
I agree to contact the foster coordinator immediately if medical attention is required.
I agree to transport the animal to the veterinarian if instructed.
I will assist with screening potential adopters.
I agree to transport the animal to adoption fairs and PetSmart on Saturdays.
I will notify CHS if I need respite or long-term care assistance.
I agree to act in the best interest of the animal at all times.
I agree to provide adequate food, water, shelter, exercise, and attention.
I agree to provide a safe environment and not allow others to care for the animal without CHS approval.
I am willing to house train and crate train my foster dog.
I will attend foster parent training and meetings.
I understand I must join CHS as a member and pay yearly dues of $10.
