Foster Application Foster Application Name First Last PhoneEmail Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Preferences (Check all that apply) Dogs Cats Puppies Kittens Nursing Dog/Litter Nursing Cat/Litter Rabbits Other Special Cases (Check all that apply) Bottle feeding Seniors Health issues Needs socialization Other How many animals can you care for at once?12345+How did you hear about the foster program?Would you allow a FHS representative to visit your home? Yes No Have you ever fostered before? Yes No If you had to keep the fosters away from your personal pets, could you? Yes No Are you able to keep appointments for follow up visits and vaccinations? Yes No Are you able to provide supplies for the animals in your care? Yes No Are your personal pets up-to-date on vaccinations? Yes No Are you able to bathe or groom your foster pet? Yes No If yes to any of the above, please describe.Please list the name, breed, sex, and sterilization statis of all your current personel pets.Please read carefully and check to agree I give permission to be photographed, interview or videotaped to publicize FHS volunteerism. This may be used in newsletters, website or other publications to raise community awareness of our work for the animals. I agree to comply with all rules and regulations that may be established by the Flagler Humane Society. I understand that my failure to comply may result in my inability to volunteer with Flagler Humane Society. I acknowledge that my services are provided on a volunteer basis without any pay or compensation of any type and without liability of any nature on behalf of Flagler Humane Society. All service performed by me are at my own risk. I recognize that in handling animals there exists a risk or injury, including physical harm caused by animals. I understand it is my responsibility to follow the Flagler Humane Society policies and procedures as described in my volunteer training and that direct supervision may not be available at all times. On behalf of myself, my heirs, personal representatives, and executors, I hereby release, discharge, indemnify, and hold harmless the Flagler Humane Society, Inc., its agents, servants, employees and board members from any and all claims, cause of action or demands and any mature of including costs and attorneys’ fees incurred or sustained by me in any way connected wth my services performed at Flagler Humane Society, including but not limited to: Animal bites/ scratches, accidents, injuries, property damage and/or medical fees.
