Waterford Foster Care Application

* required information
 
Contact Information
Title:
First Name:*
Last Name:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Email:*
Phone:*
Business Phone:
Cell Phone:
Highest Education Level:*
Current Employer or School:
Job Title:
How did you hear about us?:
If other, please enter how you heard about us:
Contact Preferences: Yes, I would like to receive e-mail from The Connecticut Humane Society
Yes, I would like to receive postal mail from The Connecticut Humane Society
Additional Information
Are you available to volunteer for at least 6 consecutive months?:* Yes
No
Are you 18 or older? (Children interested in Foster Care must have an adult complete this application.):* Yes
No
Are you currently employed?:*
Do you have reliable transportation?:* Yes
No
Are you willing to use your car to transport animals as part of your volunteer work?: Yes
No
Do you have current health insurance? (Active health insurance is required for all volunteer positions):* Yes
No
Have you been convicted of a crime in the past 7 years?:* Yes
No
If you have been convicted, please list the nature of the offence.:
Are you volunteering to meet mandatory community service requirements?:* Yes, for a school or church program
Yes, for the judicial system
No
If yes, how many hours must you complete?:
When is the deadline?:(mm/dd/yyyy)
Why do you want to volunteer for the Connecticut Humane Society?:*
Please list previous work experience. (Name of employer/job title):
Please list volunteer experience. (Name of organization/job title or assignment):
What skills do you have that might be useful to CHS?:
List any animal welfare or other animal related groups you have belonged to.:
Do you have any professional experience working with animals? Please explain.:
What types of animals have you owned? (List species/breed):
Are you able to meet the requirements of the listed position?:
If with, what accommodations might you need?:
Have you ever been employed by the Connecticut Humane Society or Fox Memorial Clinic?:* Yes
No
If yes, when?:
Have you ever applied to volunteer at the Connecticut Humane Society or Fox Memorial Clinic?:* Yes
No
If yes, when?:
Have you adopted a pet from the Connecticut Humane Society?: Yes
No
If yes, when?:
CHS adopts over 96%, but euthanizes for serious medical/behavioral issues. What is your philosophy on euthanasia?:*
Please list all members of the household. If under 18, list their age.:*
Please list all pets that currently reside in your home (species/breed/name).:
Are they all spayed/neutered?: Yes
No
Are your pet(s) currently healthy and up to date on their vaccinations and/or vaccine titers?: Yes
No
Who is your veterinarian? (Name/phone #):
Where do you live?: Single Family Home
Condo
Duplex
Apartment
Other
Renters, do you have permission to have pets in the dwelling?: Yes
No
If yes, can you furnish written proof?: Yes
No
Do you have a fully fenced-in yard?: Yes
No
Please list any experience you have with training, housebreaking or socializing animals.:
Are you at home during the day? (Nursing animals need to be fed every 2 - 4 hours.):* Yes
No
How many hours a day would foster pets be left alone?:*
In the event of a medical emergency, can you get your foster pet to CHS on short notice?: Yes
No
Are you able to foster pets away from owned pets if necessary?:* Yes
No
N/A
Please describe the room where you will be housing your foster pets.:*
Do you have experience caring for animals under 8-weeks old?: Yes
No
What type of animals are you interested in fostering?: Dogs
Cats
Both
Check the areas you are interested in:: Pregnant animals
Mothers with litters
Behavior modification/Socialization
Infant puppies/kittens (bottle-feeding)
Self-Sufficient puppies/kittens
Surgery/Medical recovery
Have you ever done foster care for CHS before?: Yes
No
Please list 2 references (non-relatives) who have recently been to your home, their phone or email, and relationship to you.:*
I verify that all information provided is true and accurate.:* Yes
No
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Thank you for your interest in volunteering for our organization. You will receive a confirmation email once your application is submitted. We receive a high volume of applications every week. Please allow us up to two weeks to review your application. Thank you in advance for your cooperation.
        

Waterford Foster Care Application

Connecticut Humane Society

701 Russell Road, Newington, CT 06111
800-452-0114 | FAX 860-665-1478   info@cthumane.org 
The Connecticut Humane Society is a 501(c)(3)
non-profit organization. EIN: 06-0667605
Copyright 2013 Connecticut Humane Society

Copyright 2013 Connecticut Humane Society