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Second Hand Seniors (SHS) Foster Application & Foster Care Responsiblities Agreement
Instructions: Please print the application, complete the questions, sign and return to Second Hand Seniors. Thank you for helping us save senior shelter dogs.
Name: _________________________________________
Address: ____________________________________
(Apt. #): _________________
City: ___________________ State: ____ Zip: ________
Home Phone with Area Code:____________________
Occupation: _______________________________
How long with current employer:__________________
Work Phone with Area Code: ____________________
Mobile Phone with Area Code:_________________________
E-mail: ____________________________
1. Do you live in a house? _____ Apartment? ______ Condo? _____
Do you rent? _____ Own?_____
If you rent, do you have the landlord's permission to keep a dog? _______
[Please attach the form to your application]
Do you have a yard? ______ Is it fenced? _______
What type of fencing? ______ chain ______ wood _______ other (please describe)
2. Is someone home during the day? _______ Please explain:
3. What provisions will be made for your foster animal if nobody is home during the day?
Loose inside? _______ Confined to an area inside?________
Confined to an area outside? _________ Is there a dog house? _________
In crate? _______ What size crate? _______ For how long each day?_________
4. Where will the dog sleep? Please explain:
5. Have you lost a pet (as in missing)?
Have you lost a pet through death?
If yes, what did the animal die of?
6. Do you have children at home? Yes ______ No ______ Number: _____ Age(s): _______
[Second Hand Seniors trusts that your children are experienced with and kind to animals. It is your responsibility to supervise your children when interacting with any foster pet. Please note: Because we cannot know all the personalities and behaviors of the children, we will not place our dogs in homes that have a baby sitting / day care home business.]
7. Do you have other pets at home? Yes ______ No_____ Number: _____
Ages(s): ______
If Yes, are the pets neutered? Yes ______ No _____
If Yes, are the pets vaccinated? Yes_____ No_____
If yes, do your pets get along with other dogs? Yes _____ No ______
8. Are you prepared to assume the responsibilities of feeding, bathing, grooming (toe nails may only be clipped by a vet), and caring for your foster animal, including emotional rehabilitation for a traumatized dog?
Yes ______ No ______
9. Will you follow all veterinarian instructions provided and administer all prescription medications to your foster? Yes ______ No ______
We do not allow our fosters to give foster pets over the counter items such as vitamins, human medication, unprescribed pet medicines, etc.
Do you understand and agree to these conditions? Yes:____ No:_____
10. Are you prepared to assume the responsibilities of contacting Second Hand Seniors officials for any medical emergencies? (For example, if a dog is going through Heartworm treatment and begins throwing up and becomes listless, this may be an emergency).
Yes ______ No ______
11. Do you agree that our Coordinators make all medical and adoption decisions for our program dogs? Yes ______ No ______
12. Though Second Hand Seniors does not accept vicious dogs into our program, we do not know the histories of many of our rescues. Are you prepared to contact us immediately if your foster dog bites anyone, injures another pet or becomes injured? Yes ______ No ______
13. Second Hand Seniors does not allow fosters to surrender a pet to any animal control agency regardless of the circumstances. Do you understand that you do not have legal authorization to surrender this animal to anyone?
Yes____ No____
14. Will you keep the dog confined in a fenced yard when let outdoors, walk/exercise the dog regularly, and allow the dog indoors?
Yes ______ No ______
15. Do you understand that some animals are known for being 'barkers'? Yes _____ No _____
16. Do you understand that some dogs can be shy and aloof with new people? Yes _____ No: ______
17. Do you understand that if you wish to adopt your foster dog, you must complete the adoption papers? Yes ______ No _______
18. Are you willing to allow a Rescue Program representative to visit your home by appointment? Yes: ______ No: _______
19. Second Hand Seniors does not place animals in foster homes where a person in the home has been charged with animal cruelty, abuse or neglect.
Has anyone in your home been charged with animal cruelty, abuse or neglect?
Yes:_____ No:_____
20. Second Hand Seniors does not reimburse fosters for medical expenses. All medical treatments and visits must be pre-approved through SHS. All foster pets under this application must be treated at approved Second Hand Seniors' Vet Clinics.
Do you understand and agree to these conditions? Yes:_______ No:_______
21. Second Hand Seniors does not allow fosters to make placements, rehome or give away the fostered pet. All adoptions must be conducted through SHS.
Do you understand and agree to these conditions? Yes:_______ No:________
22. If you decide you can no longer foster this pet, you must give Second Hand Seniors adequate time to make arrangements to place the pet with another foster and arrange for transportation. You should give at least 30 days notice.
Second Hand Seniors is foster based meaning we must have another foster available before we will remove the pet from you. In the event that you can no longer foster, we agree to diligently look for placement if no other foster has an opening. However, you must understand that you must continuing housing your foster pet until alternate placement is arranged. If you cannot foster the pet until alternate placement is found. We will allow you to board the pet at Waggin Tails http://www.waggintailsdaycare.com/ at our rescue rate which is currently $10 per day.
Do you understand and agree to these conditions? Yes:______ No:______
If you fail to give the required notice, you will be responsible for boarding fees. Do you understand these terms? Yes:____ No:_____
23. Second Hand Seniors does not allow fosters to surrender fostered pets to animal shelters. If you surrender this pet to a shelter SHS can and will pursue legal action against you and you will be required to pay all cost involved.
Do you agree not to surrender this animal to any shelter? Yes: ______ No:_______
24. If an emergency arises, you must contact Second Hand Seniors immediately.
Do you understand and agree to this condition? Yes: ______ No:______
25. Adoption information is confidential.
Do you agree to keep all adoption information confidential? Yes:_____ No:______
26. Second Hand Seniors does not allow foster pets to be chained, staked, muzzled, drugged or tied.
Do you understand and agree to these conditions? Yes:____ No:_____
27. Second Hand Seniors does not allow fosters to hit, strike, harass, annoy, or prevoke any fostered pet.
Do you understand and agree to these conditions? Yes:____ No:_____
28. Second Hand Seniors does not allow fostered animals to be breed or fought.
Do you understand and agree to these conditions? Yes:___ No:_____
29. Second Hand Seniors requires that this animal be kept in clean living conditions and have sturdy shelter at all times.
Do you understand and agree to these conditions? Yes:____ No:____
30. Most senior shelter animals are already spayed or neutered when they come into our program. Second Hand Seniors promotes spay and neuter when combined with common sense. All seniors in our program will be assessed by our vet regarding the pet's need for spay/neuter. In the event that SHS feels that spay or neuter is in the best interest of the pet,
Are you willing to take this pet to his spay/neuter appointment, pick the pet up from the clinic on time, follow the clinic's instructions for after care and recovery and contact Second Hand Seniors immediately if any medical problems arise from the surgery? Yes:______ No:_______
Please describe the recovery area you will provide for this pet:
31. Due to age and/or medical problems not all seniors in our program will be spayed or neutered. Do you understand that the risk to a senior pet may outweigh the benefit of spay or neuter and that the decision to spay or neuter is solely SHS' decision to make? Yes ______ No ________
32. All pets in foster care must be current on their rabies shot (unless a medical condition prevents vaccination) and their rabies tag must be securely affixed to their collar at all times. The collar must be worn by the pet at all times.
Do you understand and agree to these terms and conditions? Yes:_____ No:______
33. Second Hand Seniors reserves the right to refuse any foster application for any reason. SHS also reserves the right to remove any foster pet for any reason with or without notice.
Do you understand and agree to these terms and conditions? Yes:____ No:_____
34. If you plan to move, you must notify SHS immediately. We do not allow our pets to be taken outside approved areas.
Do you understand and agree to these conditions? Yes:_____ No:_____
35. Dogs are not guaranteed to be house trained. Dog's can damage items, chew, bite, bark, urinate and deficate. Do you agree to hold Second Hand Seniors harmless should any of this incidents occur? Yes:_____ No:_____
36. Second Hand Seniors requires that all foster pets have clean fresh drinking water accessible at all times. SHS also requires that all foster pets be fed regularly (at least once per day).
Do you understand and agree to these conditions? Yes:____ No:____
37. SHS requires that all chemicals and hazardous materials be kept away from foster pets at all times (such as antifreeze/ dogs can easily chew through the container). If a pet is poisioned while in your care, you are required to provide (immediate) emergency medical care through a licensed vet.
Do you understand and agree to these conditions? Yes:_____ No:____
38. What is your plan of action if a fight breaks out between dogs while in your care? Do you have a seperate containment area?
Please explain:
39. Have you fostered for other rescue groups before? Yes____ No____
If yes, please give reference
40. Are you currently fostering for another rescue group? Yes_____ No____
41. Please list any rescue experience/affiliations
42. Will you continue to accept foster pets from other rescues while fostering this pet? Yes:____ No:____
Shelter pets can carry a variety of diseases that often go undetected by shelter employees. Since we are responsible for the medical expenses of this pet, we must limit the number of risk that we will allow the pet to be exposed to. In an effort to do this, we require that you notify us 30 days prior to accepting a new foster pet especially if the pet is coming from or has been in a shelter within the last 10 days so that we are given an opportunity to remove our pet.
Do you understand and agree to these conditions? Yes:_____ No:____
43. If you are fostering more than 20 miles from the DFW area and decide that you can no longer foster the pet, you will be required to transport the pet back to our boarding facility in Plano. Do you agree to transport the pet back to this area at an agreed upon date, place and time if you can no longer foster the pet? Yes:______ No:_____
I am in full agreement with Second Hand Seniors Rescue Program & Foster Care Responsibilities.
By signing below I am attesting to the truthfulness of my answers and agree to be bound by the terms and conditions mentioned above. I understand that an electronic version of this agreement is just as binding as the original document.
Date: ________________
Signature: __________________________________
Driver's License Number & Issuing State ___________________________
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