Houston SPCA: Survey - Domestic Foster Application

Domestic Foster Application

1.

Please provide us with the requested information below:

*

First Name: Required

*

Last Name: Required

*

Email: Required

*

Street 1: Required

Street 2:

*

City: Required

*

State / Province:

State / Province: Required

*

ZIP / Postal Code: Required

*

Phone Number: Required

*

Date of Birth: Required

Date of Birth:

Month

Day

Year

Yes, I would like to receive e-mail from Houston SPCA

*2.

Question - Required - Work Phone Number

*3.

Question - Required - Mobile Phone Number

*4.

Question - Required - Emergency Contact phone number:

*5.

Question - Required - Current Employer

*6.

Question - Required - Number of Years with Employer:

*7.

Question - Required - Are you a member of any animal organization?

8.

Question - Not Required - If yes, please describe:

(Maximum response 255 chars, approx. 5 rows of text)

*9.

Question - Required - What type(s) of animals are you interested in fostering?
Please make between 1 and 6 selections from the choices below.

	Cats
	Dogs
	Kittens
	Puppies
	Small Mammals
	Healthy Adoptables Only

*10.

Question - Required - How many children are in your home? What are their ages? Please explain how they will help with care of your foster animals.

*11.

Question - Required - Are currently a volunteer with the Houston SPCA?

12.

Question - Not Required - If yes: How long have you been a volunteer and in what areas do you donate your time?

*13.

Question - Required - Have you ever been employed by the Houston SPCA?

14.

Question - Not Required - If so, please list employment dates.

*15.

Question - Required - Do you live in a house on the site where animals would be fostered?

16.

Question - Not Required - If no, please explain.

(Maximum response 255 chars, approx. 5 rows of text)

*17.

Question - Required - Do you live in a:
Please make 1 selections from the choices below.

	House
	Apartment
	Duplex
	Other

*18.

Question - Required - Do you own your home?

19.

Question - Not Required - If you do not own the home in which you live, will your landlord allow you to temporarily house foster animals in your home?

*20.

Question - Required - Do you have tenant restrictions that apply? If yes, please list all that apply.

*21.

Question - Required - Have you or a family member ever been charged with or convicted of animal abuse or had animals in your possession ever been seized?

22.

Question - Not Required - If yes, please explain.

(Maximum response 255 chars, approx. 5 rows of text)

*23.

Question - Required - Are you willing to foster animals that the Houston SPCA has no background information on? (This can occur with abandonment, stray and cruelty animals.)

24.

Question - Not Required - Please supply the following information for all dogs in your home: Age, Sex, Breed, Spayed or Neutered, Date of last Vet exam, Date of vaccinations (rabies, DHLPP, Kennel Cough/Bordatella.)

25.

Question - Not Required - Please supply the following information for all cats in your home: Age, Sex, Breed, Spayed or Neutered, date of last vet exam, date of vaccinations (rabies, FVRCP, FeLV.)

26.

Question - Not Required - If you currently have cats in your home, do they go outside at any time over than under your direct supervision? If yes, please explain.

27.

Question - Not Required - Have cats in your home ever been tested for Feline Leukemia and/or Feline Immunodeficiency Virus (Feline AIDS)? If yes, please provide date of test and results.

*28.

Question - Required - The Houston SPCA recommends that foster animals be isolated from resident pets for a period no less than 14 days. This will help minimize possible exposure of transmissible diseases to resident animals. Explain the manner in which you will keep your foster(s) isolated from resident pets for 14 days if applicable.

(Maximum response 255 chars, approx. 5 rows of text)

*29.

Question - Required - Upon approval into Houston SPCA's Foster Program, I agree to abide by all policies pertaining to the program and uphold my responsibilites to the Houston SPCA and the foster animals in my care at all times. I certify that the information is true and accurate to the best of my knowledge. I understand that providing false information can lead to removal from the Houston SPCA Foster Program.