Name* Mr.Mrs.MissMs.Dr.Prof.Rev.Mx.None Prefix First Last Address* Street Address Apt./Unit City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Cell Phone*At which CHS location do you volunteer?*NewingtonWaterfordWestportWhat types of animals are you interested in fostering? Check all that apply.* Dogs under 50 lbs. Dogs over 50 lbs. Cats Small animals (rabbits, guinea pigs, etc.) Check the areas you are interested in.* Medical Cases Training/Socialization Pregnant Animals Mothers with Litters Infants (Bottle Feeders) Crisis Fostering (owned pets) Please list all members of the household. If under 18, list their age.*Do you have any pets currently residing in your home?* Yes No Please list all pets that currently reside in your home (species/breed/name).Are all dogs and cats in your home current on their rabies vaccination?All dogs and cats must be current on their rabies vaccination. Proof of vaccination status may be required in certain circumstances, such as a bite between an owned pet and a foster pet. Yes No N/A Are they all spayed/neutered? Yes No Who is your veterinarian? (Name/phone #)Are you able to keep foster pets away from owned pets if necessary?* Yes No Please list any experience you have with training, housebreaking, or socializing animals.How many hours a day would foster pets be left alone?*If your foster pet becomes sick or is experiencing a medical emergency, are you able to get the pet to CHS on short notice?* Yes No I verify that I meet all the Essential Capabilities listed below.* Yes No PHYSICAL CAPABILITIES • Ability to see to distinguish animal body language and read instructions. • Ability to hear warnings, such as growling or hissing. COGNITIVE ABILITIES • Ability to understand, remember and follow both verbal and written instructions and procedures. • Basic reading, writing and communication skills. • Ability to recognize potentially hazardous situations. • Ability to understand and safeguard against the risk of exposure to zoonotic diseases such as ringworm or animal bites or scratches.CAPTCHAThank you for submitting your application to volunteer for the Connecticut Humane Society. Due to the high volume of applications received, please allow up to two weeks to hear back on the status of your application. CHS is not able to process applications that do not meet the basic requirements.
