Support NHS

1.

Contact Information

*

Name:

First Required	Last Required

*

Email: Required

*

Street 1: Required

*

City/State/ZIP:

City Required	State Required	ZIP Required

Yes, I would like to receive e-mail from Nebraska Humane Society

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*2.

Question - Required - You must live within 30 minutes of the shelter- 8929 Fort street, Omaha- for emergency purposes, no exceptions. Do you live in a 30 minute radius?

*3.

Question - Required - Daytime Phone Number

*4.

Question - Required - Evening Phone Number

*5.

Question - Required - Type of animal(s) you are interested in fostering. Please check all that apply.

	Dogs
	Puppies
	Nursing Dog with Puppies
	Cats
	Kittens
	Nursing Cat with Kittens
	Other

*6.

Question - Required - How did you hear about our program?

*7.

Question - Required - Do you live in a:

Home

Apartment

Duplex

8.

Question - Not Required - If you rent, we will need to verify your landlord's pet policy. Please provide your LANDLORD's or leasing agents name and telephone number and name of complex.

*9.

Question - Required - Please list the number of adults in the home, and their names. If you have children please list the number of children and their ages.

*10.

Question - Required - Have you ever fostered an animal before?

11.

Question - Not Required - If yes, what kind?

*12.

Question - Required - Do you have a separate room to keep a foster animal in at your home? Please note, to foster kittens and/or cats you MUST have a separate room in which to keep them.

*13.

Question - Required - If fostering a dog, do you have a fenced yard?

14.

Question - Not Required - If you answered yes to having a fence, what type and how high?

*15.

Question - Required - Have you, a family member, or any member living in the home where the animal will be fostered ever been convicted of any animal related misdemeanor or felony offense?

16.

Question - Not Required - If you answer yes to the previous question, please describe.

*17.

Question - Required - How long are you able to foster an animal?

*18.

Question - Required - Are you willing and capable of giving medication if needed?

*19.

Question - Required - Are you applying to be a permanent foster caregiver or an emergency foster caregiver?

*20.

Question - Required - What hours are you generally home to provide care for your animals? Is someone home during the day?

*21.

Question - Required - Are you able to leave work to tend to them during the day?

*22.

Question - Required - Where will the animals be kept in your home? (Day, Night?) (Example: living room during day, laundry room at night)

*23.

Question - Required - Describe the location and flooring. (Example: Laundry room, wood floor)

*24.

Question - Required - Please list all current animals in your home. Please provide name, breed age, and sex (spayed or neutered)

*25.

Question - Required - We will need to verify that all your animals are current on their vaccinations. Please list your veterinarian's name and phone number so we may contact them.

*26.

Question - Required - What are your animals vaccinated against?

I certify that the above information is true, and that I have read the information regarding the requirements and responsibilities of being a foster parent, and feel capable of performing these duties.

I understand that there may be expenses involved in fostering, and will abide by the guidelines set forth by the Nebraska Humane Society for reimbursement of certain expenses. I further understand that there is a danger inherent in handling animals, and that I agree to hold harmless and indemnify Nebraska Humane Society from any injuries or loss sustained by me or others, which may be caused by the animals(s) I am fostering.

*27.

Question - Required - By typing your name below your agree to the above statement.

*28.

Question - Required - Date:

Month

Day

Year

*29.

Question - Required - Are you a robot? Enter the text below!

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