Survey - Equine and Farm Animal Foster Home 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: Required
*	ZIP / Postal Code: Required
*	Phone Number: Required
*	Date of Birth: Required	Date of Birth:
	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:

*5.

Question - Required - Current Employer

*6.

Question - Required - Number of Years with Employer:

*7.

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

	Equine
	Cattle
	Goats/Sheep
	Fowl
	Pigs
	Other

*8.

Question - Required - Do you have children? If yes, please list their ages and please explain how they will help with care of your foster animals.

*9.

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

10.

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

*11.

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

12.

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

*13.

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

14.

Question - Not Required - If no, please explain.

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

*15.

Question - Required - List size of property in acres.

*16.

Question - Required - Do you own your home?

17.

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?

*18.

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

*19.

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

20.

Question - Not Required - If yes, please explain.

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

*21.

Question - Required - Are you a member of any Horse Club and/or Organization or other breed or animal shelter/rescue group? (if yes, please list any and your involvement)

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

*22.

Question - Required - Are you able to provide adequate transport for your farm foster?

*23.

Question - Required - What type of trailer do you currently use?

*24.

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.)

*25.

Question - Required - Would you be willing to foster an equine or farm animal with training issues?

26.

Question - Not Required - If so, please explain your training experience.

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

*27.

Question - Required - Would you be willing to foster an equine or farm animal with health issues? Please explain.

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

*28.

Question - Required - Would you be willing to foster an older/senior equine or farm animal?

*29.

Question - Required - Would you be willing to foster a farm animal less than one year of age?

30.

Question - Not Required - Would you be willing to foster a mare in foal?

*31.

Question - Required - Do you currently own any horses or farm animals? If so, please list species, breeds, sex, and number of each?

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

*32.

Question - Required - Please provide the following information: What was the date your equine(s) were last vaccinated? What vaccinations did your equine(s) receive? What is your deworming protocol? What do you feed your current equines? How frequently? How often are their feet trimmed?

*33.

Question - Required - In the past 5 years, have you had any equines/farm animals die in your care? If so, please explain.

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

*34.

Question - Required - Please describe your experience with equines/farm animals.

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

*35.

Question - Required - How often do you plan on having a farrier trim your foster?

*36.

Question - Required - How often do you plan to de-worm your foster?

*37.

Question - Required - If you have other farm animals, do you have adequate facilities to quarentine your foster?

*38.

Question - Required - Please describe.

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

*39.

Question - Required - Will your foster be kept in a barn or pasture? Please describe.

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

*40.

Question - Required - What kind of fencing do you have?

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

*41.

Question - Required - Is there debris in the pasture such as limbs, metal, glass, trash, other? Please describe.

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

*42.

Question - Required - Do you have liability insurance?

43.

Question - Not Required - Please describe.

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

*44.

Question - Required - Who is your veterinarian? (Please list name, address, phone number and the approximate distance from your facilities.)

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

*45.

Question - Required - Who is your farrier? (Please list contact information.)

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

46.

Question - Not Required - If your foster animal will be kept someplace other than the address given above, please list the facility, address, contact person and phone number.

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

*47.

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)

*48.

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.

Equine and Farm Animal Foster Home Application

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