Fillable Form 21: Foster Volunteer Application (Florida)

Fill Online, Printable, Fillable, Blank Form 21: Foster Volunteer Application (Florida) Form

Use Fill to complete blank online FLORIDA pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Form 21: Foster Volunteer Application (Florida)

On average this form takes 24 minutes to complete

The Form 21: Foster Volunteer Application (Florida) form is 4 pages long and contains:

  • 3 signatures
  • 8 check-boxes
  • 81 other fields

Country of origin: US
File type: PDF

BROWSE FLORIDA FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
I understand that incompleteness in disclosure of criminal records or any falsification or misrepresentation on any forms is grounds for
disqualification from the volunteer program.
Do you have a health, medical or allergies that would be affected by fostering for ACC?
No ( ) Yes ( )
If yes, please explain so that we can try to accommodate you
Please note, as a registered foster you consent to the possibility of appearing in still or motion pictures, and your name
and/or photo may be used for educational, promotional, or other purposes related to the mission of the organization.
Working in an open admission animal shelter where we accept any animal in need is emotional. For animals that are
suffering from disease, injury or other infirmities, those that pose a safety threat, or those for which a caring home
cannot be found, euthanasia is the most humane alternative. We ask that you consider our work here at the shelter
and we understand if you prefer not to work directly with the animals but still want to help in an administrative capacity.
Signature: Date:
Once your application is complete, please email to PBC-ACC-Rescue-Request@pbcgov.org. Once approved, you will
be added to the Foster email list. When you see an animal you would like to foster, simply reply to the email and
we will set up an appointment time for you to come in to pick up your foster & supplies.
Page 1 of 4
Foster Volunteer Application
Thank
you
for
choosing
to
become
a
foster
parent
for
Palm
Beach
County
Animal
Care
and
Control!
Fosters
play
an essential
role
in
helping
us
to
save
and
assist
as
many
animals
as
possible
by
providing
a
temporary
home
for
them. There
is
no
minimum
age
to
become
a
foster
parent,
but
there
must
be
an
adult
in
the
household
who
will
act
as
the primary caregiver. If you are under the
age of
21
(or older
than 21
but
still live at home)
please have
parent/guardian or
Head of Household complete the
application
below.
.
**We are now encouraging and accepting fosters for kittens and cats. Any applications received for the purposes of dog fostering will be held for future processing
(Please Print Clearly)
Name:
Birthday:
/
/
Address:
City &
Zip
Home/Cell
Phone:
Alternate
Phone:
E-Mail
Address:
DL
#
Student
Name for School Hours:
__________________Age of Student:
_______________
Have
you
ever
been
charged
with
or
convicted
of
any
criminal
offense,
plead
guilty,
or
nolo
contendere
(no
contest),
or
found
guilty
of
a
criminal
offense,
regardless
of
adjudication
or
suspended
sentencing?
(
)
Yes
(
)
No If
yes
list
nature
of
offense,
court
(City,
County,
and
State),
disposition,
and date.
Updated:
6/18/21
click to sign
signature
click to edit
Foster Caregiver Questionnaire
Palm Beach County Animal Care & Control
Date: Email:
Name: Phone#:
First Last
( ) Yes ( ) No
1.
Have you read “Things to Consider Before Fostering”?
2.
How many people live in your home? ___________________
3.
How many children under the age of 10? ________________
4.
Pet Name
Type
(dog, cat,
etc.)
Age/
Weight
License Tag #
L -
L -
L -
L -
L -
L -
*Please note, all dog and cats in the home must be current on their rabies shot and County license tag
before you can be approved as a foster volunteer.
5.
What kind of pet would you like to provide care for? Check as many as apply:
Adult Dog:
( ) 40 + pounds with Kennel Cough
( ) Bottle-fed Kitten (must have experience)
( ) Mom & Kittens
( ) Kitten
( ) Adult Cat with Upper Respiratory Infection
6.
Are you willing to treat and care for a pet that may have an illness such as Kennel
Cough (CIRD) or Feline Upper Respiratory (URI)? ( ) Yes ( ) No
7.
You must keep foster animals separate from your own pets. Are you able to keep your own animals
isolated away from the foster animal that you bring home? ___________ If unable to do so, your
application will automatically be denied.
8.
Do you foster for any other animal rescue organizations or current ACC Foster? Please list below:
Chameleon PID
__ Year Round Foster
__ Seasonal Foster
__ Need Foster Hours for School
Do you have a pet at home?
(
)
Yes
(
)
No
Please
list any pets you currently own*:
Page 2 of 4
Foster Caregiver Pledge - I understand and agree to the following (please initial):
The number of animals I am allowed to foster at one time will be limited by Animal Care & Control.
This is in the best interest of the animals needing foster care.
Foster animals must be housed indoors, in a quiet room away from other pets in the home (i.e. guest
bedroom, bathroom, laundry room, climate controlled garage). ACC Foster Animals are not allowed
to go to Dog Parks, Dog Beaches, etc. ACC Foster Dogs cannot be allowed to interact with any other
animals including your own personal pets – this is for safety and medical reasons.
The amount of time - unless legally adopted - I may foster a pet in my home, will be regulated by
ACC. (average of 2-4 weeks).
I understand that veterinary medicine is not an exact science. It is very possible that during the medical
processing of the foster pet, some illness and/or injury and/or parasites may go undetected. The
animal(s) released in the foster care program may be incubating a medical condition that could affect my
personal animal(s) at home. Animal Care & Control will not be financially responsible for the treatment
of my personal pet(s); i.e. ringworm, Sarcoptic mange, CIRD, upper respiratory infections, etc.
Animal Care & Control is able to provide basic care and medical treatment for animals; they do not
have the funding or resources to provide extensive and prolonged treatment for sick or injured animals.
Foster animals must be brought back for all re-check appointments in the time that is scheduled with the
clinic. Please contact sphillip@pbcgov.org for any medical questions/concerns.
If at any time a foster animal runs away, gets lost, is relocated, or dies, I must contact the Foster
Coordinator. If the animal(s) dies, the body must be returned to Animal Care & Control.
I will be financially responsible if I choose to bring my foster to my own veterinarian or for the
treatment of any follow-up medical care for animals that Animal Care & Control chooses not to treat in-
house due to limited resources. I do have the option of returning the animal(s) should I decide I do not
want this responsibility.
I agree to return the animal upon request, at the end of the scheduled foster period, or if I am no longer
able to adequately care for the animal.
ACC reserves the right to cancel my foster care agreement, conduct a home visit, and remove any
and all foster pets if it is in the best interest of the animal or for just cause.
Animal Care & Control reserves the right to decide the final disposition of all foster pets. This may
include denying an adoption and/or euthanasia for space and time if not adopted. The Division Director
reserves the right to make the final decision in the event of dispute.
I certify that all statements and answers to questions on this application are true.
Signature Date
Page 3 of 4
click to sign
signature
click to edit
Long and Short Term Foster Release and Waiver of Liability,
Assumption of Risk and Indemnity Agreement
Foster Care for an animal is a time period during which the animal being fostered can resolve or improve medical and/or behavioral issues and allows all
involved to get to know the animal before it is placed into a permanent home. Similarly, field trips, lunch dates, weekend sleepovers and other such short-term
foster situations serve the same purpose and thus, the release and waiver of liability and assumptions of risk apply.
While Palm Beach County Animal Care and Control (PBCACC) cannot guarantee to the foster parent/family what type of temperament the fostered animal may
have in the home environment, every measure is taken by PBCACC to ensure that animals being fostered, specifically dogs, are not exhibiting dangerous
behavior while at the shelter.
Approved Foster Parents are required to agree to provide proper care for the animal and must sign all necessary forms as required or as become necessary due to
changes in the animal’s behavior or health. Foster Parents agree to abide by PBCACC’s decisions as to the pet’s ultimate outcome and understand that the foster
pet is in their care temporarily and must be returned to PBCACC at the end of the foster period or upon request.
Release and Waiver of Liability:
IN CONSIDERATION OF BEING PERMITTED TO FOSTER AN ANIMAL FROM PALM BEACH COUNTY ANIMAL CARE AND
CONTROL, THE UNDERSIGNED:
1. Acknowledges, agrees, and represents that he/she is aware of and assumes the many risks associated with being around animals,
including but not limited to, the risk of being bitten, scratched, jumped on, knocked over, chased, tripped, infected with a zoonotic
disease, or otherwise injured or frightened.
2. Acknowledges, agrees and represents that he/she is aware of the risks of damage to personal property by the animals while fostering.
3. Acknowledges, agrees, and represents that he/she is aware that PBCACC makes no guarantee as to the behavior of the animal being
fostered and assumes full responsibility for any risk of bodily injury arising out of or related to the fostering of a pet from PBCACC.
4. Hereby assumes full responsibility for any risk of bodily injury to themselves or to their family, their own pets, guests, or other person
while the animal is their care, or any property damage arising out of or related to the fostering of any pet from PBCACC
5. Hereby releases, waives, discharges, and covenants not to file suit against Palm Beach County Animal Care and Control, the Division of
Public Safety, Palm Beach County Government or any of their respective employees, agents, members, directors, officers, or any
affiliated entities thereof, for any loss, liability, damage, or cost arising out of bodily injury or property damage related to the fostering
of an animal for PBCACC.
I have read this release and waiver of liability, assumption of risk and indemnity agreement. I fully understand its terms and understand that
I have waived substantial rights by signing it. I have signed it freely and voluntarily without any inducement, assurance or guarantee being
made to me and I intend my signature to be a complete and unconditional release of all liability to the greatest extent of the law.
__________________________________________
Print Full Name
__________________________________________ __________/_________/_____________
Signature mm dd yyyy
________________________________________________________________________________
Address City, State Zip Code
______________________________________ ______________________________________
Witness Witness
Page 4 of 4
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Form 21: Foster Volunteer Application (Florida)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 29 August 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document