Fillable Foster Home Application (Montgomery County, Virginia)

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Foster Home Application (Montgomery County, Virginia)

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The Foster Home Application (Montgomery County, Virginia) form is 6 pages long and contains:

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  • 24 check-boxes
  • 131 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Montgomery County, Virginia

BROWSE MONTGOMERY COUNTY, VIRGINIA (VA) FORMS

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1
Montgomery County Animal Care and Adoption Center
Foster Home Application
I certify that the following information is true and complete to the best of my knowledge
Signature: _________________________________________________ Date: _______________
Thank you for your interest in fostering an animal from the Montgomery County Animal Care
and Adoption Center! You are an important part of our mission to create a no-kill community.
The questions in this document are designed to help us get to know you better so that we can
find a foster animal that is the right fit for you. There are no right or wrong answers for any of
these questions so please answer them as completely and honestly as you can!
Please fill out the information below and submit the application to the Volunteer Coordinator
at charettl@montgomerycountyva.gov, fax to the shelter at 540.382.5798, mail to 480
Cinnabar Rd, Christiansburg, VA, 24073, or drop off a hard copy at the shelter.
Personal Information
Name: __________________________________________________________ Age: _________
Address: ______________________________________________________________________
Phone #1: _____________________________ Phone #2: _______________________________
Please indicate what type of phone number each one is (cell/home/work/other)
E-mail: ________________________________________________________________________
Household Information
Please list any other human residents of the home in which you live below as well as their ages
and their relationship to you. Please include any roommates.
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2
Has everyone in the household agreed to have a foster animal in the home? Yes No
Is anyone in the household allergic to dogs, cats, or other animals? If so, what type of animal is
the person allergic to?
Please briefly describe your typical weekly schedule below with the approximate number of
hours the foster animal will be left alone each day.
M:
Tu:
W:
Th:
F:
Sa:
Su:
Are children currently living in or going to be visiting your house? Yes No
If so, what is the approximate age range of the children? _________________________
Do you rent or own your home? Rent Own
If you rent, please provide the contact information (name and phone number) for your landlord
or leasing agency. _______________________________________________________________
Landlords, insurance agencies, and home owners associations often have breed, weight, or
animal number restrictions. Please speak with these agencies (if applicable) and list any
restrictions below.
3
Some agencies do not allow foster animals or require that a pet fee be paid. Please initial the
statements below.
_______I have confirmed that I am allowed by my landlord or leasing agency to have foster
animals in my home (OR I own my home).
_______I am aware that the MCACAC will not cover any fees associated with damages, pet
deposits, or monthly pet fees and I am prepared to pay these fees.
Animal Information
Please list all animals currently living in the household below.
Name Species Breed Age Sex Spayed/Neutered?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
If any animals in the household are not spayed or neutered, please explain below.
Please list any past pets you have owned but no longer have and state what happened to them
(passed away, lost, given away, sold, stolen, etc.). This does not include animals that were not
considered pets (i.e. livestock or poultry).
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
4
Have any of your resident animals ever had a conflict with another domestic animal of the same
species (ex. dog fight)? Yes No
If yes, please explain:
Are you capable of keeping your foster animal completely separate from any resident animals
should a temperament conflict or health issue arise? Yes No
Please list the name and contact information of the veterinarian who most recently cared for
your current animals. Please note that all resident animals must be up to date on rabies and
distemper vaccines and flea prevention before bringing a foster animal home.
______________________________________________________________________________
______________________________________________________________________________
Please initial:
______ I agree to let a representative from MCACAC call my veterinarian and verify that my
animals have received the proper vaccinations and that I provide recommended care.
Animal Experience
Have you ever been the primary caretaker for an animal that you owned? Yes No
Have you ever fostered an animal through a shelter or rescue? Yes No
If you have fostered before, please provide the name and contact information of the group
through which you did so. ________________________________________________________
______________________________________________________________________________
Do you have any animal experience other than owning a pet? (Examples: working at a
veterinarian’s office, boarding facility, laboratory, or other shelter.) Please describe below.
5
Foster Animal Preferences
What type of animal(s) are you willing and able to foster?
Cat Dog Pocket Pet Livestock/Poultry Pet Bird Reptile/Amphibian
Animals generally go into foster care because they are struggling to thrive in the shelter
environment. What situations do you feel equipped to handle?
Behavioral issues Injured animal
Pregnant mother Ill animal (non-contagious)
Lactating mother with offspring Ill animal (contagious)
Orphaned neonates Weaned puppies or kittens
Shy animals High-energy animals
Hospice care Long-term fosters (over one month)
Are you willing and able to do any of the following activities for your foster animal?
Please check all that apply.
Take to the vet Transport to the shelter or shelter events
Give medications Use basic positive reinforcement training techniques
Housetrain (dogs) Follow instructions for any special care
Please describe where you plan to house your foster animal when you are at home.
Please describe where you plan to house your foster animal when you are away from home.
How do you plan to exercise your foster animal and provide mental stimulation? How much
time do you have to provide exercise? Please note that foster dogs are NOT permitted to
attend dog parks with unknown dogs.
6
Initials and Signature
______ I have read this application in its entirety and certify that all statements are truthful
under penalty of perjury under the laws of the state of Virginia.
______ I certify that I have never been convicted of animal neglect, cruelty or abandonment.
______ I understand that a representative from MCACAC will come to my residence for a home
check before allowing me to bring home a foster animal.
______ I understand that foster animals remain the property of the MCACAC and I may not give
custody of the animal to another person or entity until expressly permitted to do so by a staff
member of the MCACAC.
______ I understand that all decisions about the placement or disposition of the animal will be
made by the MCACAC.
______ If accepted as a foster home, I agree to read the foster care handbook thoroughly and
abide by all policies and procedures outlined therein.
______ I understand that for each animal I foster I will also have to carefully read and sign a
Foster Care Agreement, separate from this Foster Home Application, and that the Agreement is
a legal contract between the MCACAC and myself, the foster care provider.
Printed Name: __________________________________________________________________
Driver’s License Number: __________________________________ State: _________________
Signature: ______________________________________________________ Date: __________
--------------------------------------------------OFFICE USE ONLY-----------------------------------------------------
Please circle one: Approved Denied
Printed Name: __________________________________________________________________
MCACAC Position Title: __________________________________________________________
Signature: ______________________________________________________ Date: __________
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Foster Home Application (Montgomery County, Virginia)

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Completed 14 February 2021

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