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?*NewingtonWaterfordWiltonWhat 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.I agree to the following statement: • I understand there are risks involved when working with animals and will not hold CHS responsible for injury, illness or property damage. • I understand that all CHS foster pets remain the property of CHS and are to be returned as directed. CHS reserves the right to examine the animal or request their return at any time. • I understand that fostering does not guarantee I can adopt my foster pet. I will let my Foster Coordinator know ASAP if I want to adopt or if I have a friend or family member interested in adopting.* Yes No CAPTCHAThank you for your interest in fostering pets in need. We will be in touch within two weeks.
