- -
FIRST
CONTACT:
POSITION:
ORIENTATION
DATE:
ENTERED IN
VOLGISTICS
FOR ADMINISTRATIVE USE ONLY
APPROVED BY
FOSTER
Companion Animal Foster Volunteer Application
Dane County Humane Society
Dane County Humane Society is currently recruiting Companion Animal Foster volunteers to support our
mission Helping People Help Animals. Fill out one foster application per household, and include the
information for the primary adult contact.
VOLUNTEER INFORMATION Fill out one foster application per household. Select ONE adult to represent
the household and provide their information on this application.
Legal Name: ______
Last First Middle (full)
Birth Date: Driver’s License #:
E-mail address:
E-mail is our preferred method of contact. Our e-mail may be blocked by your filters; please check your junk e-mail folders
if you have not received an e-mail from us confirming receipt of your application within two weeks of submission.
Home (local) address:
City: State: Zip:
Phone (Home): (Cell): (Work):
May we call your work phone? Yes No May we send you a text on your cell phone? Yes No
Emergency contact: (Name, phone number & relationship) ______
BACKGROUND INFORMATION
Occupation and Employer:
Normal working hours: __________________________________________________________________
Do you have transportation? Yes No
Have you volunteered with a Humane Society in the past? Yes No
If yes, please identify the name of the organization, the time period volunteered and what you did:
Are there any medical conditions that may affect your ability to perform certain tasks? Yes No
If yes, please explain:
Have you ever been convicted of a misdemeanor or felony? Yes No
If yes, please explain*:
*All adult applicants will have background checks prior to beginning their volunteer commitment with Dane County Humane Society.
As a foster parent we require a six month commitment and minimum fostering of one animal or group of animals
during that time. Are you able to make this fostering commitment? Yes No
If no, please explain
*The need of fostering of companion animals fluctuates dependent upon seasonal population growth and our shelter’s animal
intake. Our highest needs are during the months of May through October, but foster families are ALWAYS needed.
Special events hosted by staff and volunteers are held throughout the year, to raise money and awareness about the
vital work we do. Would you like to know about our Special Event opportunities? Yes No
HOUSEHOLD INFORMATION:
Do you rent your home? Yes No Do you have landlord permission to foster? Yes No
What is your landlord’s name and phone number? ___________________ _______
Do you own your home? Yes No If yes, is the property under your name? Yes No
If no, whose name is it under?
What is their relationship to you?
Does your place of residence: Have a fenced in yard? Have secure screens in the windows?
If needed, can you isolate the foster animal in a separate room?
Do you travel often? Yes No If yes, how often? _________________________________
How many hours can you devote to foster care during the: Day ___ Evening ___ Weekend ___
Are there any children in the home? Yes No
If yes, what are their ages?
Do you intend to have your children help with animal care? Yes No
Please describe your previous animal handling experience: i.e. medical care, socialization, training, weaning.
What are your feelings about euthanasia of homeless animals for health or temperament problems?
CURRENT HOUSEHOLD PETS
Species
Breed
Age
Sex
Spayed or
Neutered?
Health
Temperament
(General Behavior)
How does your pet(s) react to new animals? _______________________________________________________
How does your pet(s) react to stressful situations, such as change in their daily routine?
_______________________________________________________________________________________________
We will need to verify your pet’s vaccination status for both your animal and our foster animal’s health protection.
Name of your veterinarian clinic: _______________________________ Phone Number: _________________
Are your animals current on the following vaccinations? Rabies Yes No Distemper Yes No
FO
STERING INTEREST - check any you are interested in:
Cats
Dogs
Critters
URI
Kittens
Mom & Kittens
Injured/Recovering
Under-Socialized
Injectables/SQ Fluids
Neonates/Unweaned
Puppies
Mom & Litters
Injured/ Recovering
Stressed
Under-Socialized
Neonates/Unweaned
Birds
Ferrets
Guinea Pigs
Reptiles
Rabbits
Rats
Small Rodents
Check ALL AVAILABLE days and times you are available
(This helps us to schedule upcoming trainings and know your availability for foster appointments.)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
8-10am
10am - noon
noon - 2pm
2-4pm
3-5pm
5-7pm
Please identify other adults (18 years and older) living in the household, do not include the applicant’s name
(All adults in the foster household will have background checks)
Last name First name Middle (full) Birthdate
______
______
______
______
VOLUNTEER APPLICATION AGREEMENT: I certify that the statements made in this volunteer application are true and have been given
voluntarily. I understand that this information may be disclosed to any party with legal and proper interest, including for such purposes as
criminal background checks, and I release the agency from any liability whatsoever for supplying such information. I also understand that I will
not be paid for my services as a volunteer. In consideration of Dane County Humane Society accepting my application, or my child's, for
participation in its programs, I agree to release and hold harmless Dane County Humane Society from and against any and all loss, damage,
claims, liability, costs and expenses of any nature whatsoever, including without limitation, attorney's fees and disbursements, arising from or
occasioned by my participation in Dane County Humane Society programs. I understand there are certain risks inherent in handling animals and
I accept these risks. I agree that Dane County Humane Society may photograph my participation in this program and I hereby release any such
photographs to Dane County Humane Society for use in its programs, publications and purpose.
I agree to pay a $20 non-refundable fee if I choose to become a volunteer at the volunteer orientation. __________ (Initials)
Applicant Signature: Date: __________
Please mail application to: Attn: Foster Team or send by Fax: (608) 838-0368
Dane County Humane Society or scan, sign and email to: dchsfoster@giveshelter.org
5132 Voges Road
Madison, WI 53718
Revised 10-23-18
click to sign
signature
click to edit