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Friends for the Dearborn Animal Shelter
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Upcoming Events
May 23, 2013 6:00 pm
Play Date - Medium Dog
May 25, 2013 12:00 pm
Offsite Adoption - Pet Supplies "Plus" (Dearborn)
May 27, 2013 10:00 am
Dearborn Memorial Day Parade
View All Events
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Volunteer
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Become a Foster
•
Foster Volunteer Application
Foster Volunteer Application
Foster Volunteer Application
1. Name
*
First
Last
1a. Are you currently a volunteer for the Friends?
*
Yes
No
2. Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip Code
3. Phone
*
Enter phone number as (###)###-####, no spaces
4. E-mail Address
*
5. Driver’s License Number
6. Date of Birth
*
7. Occupation
8. Place of business
9. Please check one:
Own
Rent
Live with parents
Other
10. Type of residence (house, apt, etc.)
11. If other, please explain:
12. Landlord’s name and telephone number, if applicable:
13. How long have you been at your current address?
14. If answer to above is less than 1 year, please give previous address:
Street Address
City
State / Province / Region
Zip / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Northern Mariana Islands
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
15. If applicable, how many children do you have?
16. What are their ages?
17. If applicable, how many adults (not including yourself) live in your home?
18. Please list the animals you have owned in the past 5 years and their names, breeds, ages. Are they sterilized, currently on medications? What happened to the animals?
19. Please list the name of your current veterinarian
20. Address
21. Phone
22. Does everyone in your household want to foster? If not, please explain:
23. Who will be the primary caretaker of the foster animal?
24. Do any members of your family have allergies to animals?
Yes
No
25. If yes, who?
26. This foster needs to get along with
Dogs
Cats
Other animals
N/A
27. If other, what type?
28. I have ____ indoor dogs; ____outdoor dogs; ____indoor cats; ____outdoor cats; ____other pets; ____livestock.
29. I need a foster that will tolerate being alone ____ hours/day.
30. When I am not at home, or not able to supervise the foster, it will be:
Loose in the house
In the yard
In the garage
In a room in the house
Crated in the house
31. I have/am planning for:
A fenced yard
A stationary tie-out
An outdoor run
Invisible fencing
A dog house
32. Someone in my home is nervous or unsure of cats/dogs:
Very (e.g., bitten as a child)
Somewhat (has had little or no experience)
No
33. The noise/activity level in my home is usually:
Low
Medium
High
The length of time an animal requires foster care is dependent on the individual animal and its individual needs. Some animals are ready for adoption within a week, while others may take several weeks to months to be ready to find their forever home.
34. Please indicate what you would be willing to foster.
Sick/Injured cat
Young kittens
Mother w/kittens
Bottle kittens
Socialize Cat
Sick/Injured dog
Young puppies
Mother w/puppies
Bottle puppies
Socialize Dog
35. Are there any factors that may limit your foster work?
Please include one reference. The reference should not be an immediate family member.
36. Name
First
Last
37. Address
Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Northern Mariana Islands
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
38. Phone
39. Relationship
40. How did you hear about the Friends For the Dearborn Animal Shelter?
Off-site adoption event
Friend/family member
TV
Newspaper
Radio
Website
Event
Other
41. What TV, Newspapaer, Radio, Website, Event, or Other...
**By clicking submit, I certify I will be doing volunteer work for the Friends For the Dearborn Animal Shelter (FFDAS), and I do hereby release, hold harmless, and indemnify the Dearborn Animal Shelter, FFDAS, their employees, volunteers and agents, and the City of Dearborn from any and all damages or liability relating to the animal(s) entrusted to my care. I fully understand the risk of bringing a foster animal into my home and take full responsibility for any damage a foster animal may cause. I do not expect FFDAS or the Dearborn Animal Shelter to reimburse me for any damages caused by an animal that I choose to foster. I understand that until the foster animal is returned to the Dearborn Animal Shelter, I will be legally responsible for any damages to the person or property of others, and/or to the animal, that results from my own negligent conduct, or the negligent conduct of those to whom I may have entrusted the animal. I understand that FFDAS may terminate my services as a foster parent at any time, with or without reason. I acknowledge that the animal(s) are the sole property of the Dearborn Animal Shelter. I will return the animal(s) to Dearborn Animal Shelter upon request or if I am no longer able to care for it/them.
Name
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