Nebraska Humane Society Foster Care Volunteer Application Form

Thank you for your interest in opening your home to an animal in need. Foster homes provide a temporary safe place for some of our most vulnerable animals to rest and heal. Foster families also care for kittens and puppies until they are old and big enough for adoption. If you aren’t ready or able to adopt an animal to provide a permanent home, but are looking for a way to help an animal in need temporarily, fostering is a very rewarding way to prepare an animal for its forever home.

Please complete this application form. Once you complete the form, click the Continue button at the bottom.

Prior to completing the application, please review the information below.

• You must be at least 19 years of age

• We ask that you provide a foster home to an animal in need at least one time per year

• You must agree to a home visit prior to fostering

• You must have a flexible schedule that allows you to bring your foster animal to NHS for scheduled vet visits

• You must live in Nebraska and within 30 minutes of Nebraska Humane Society

• If you rent, you must maintain compliance with the pet policy as indicated on your lease agreement

• You must be willing to participate in required training provided to NHS foster care givers

• You must have access to an active email account that you will check regularly to receive emails about animals needing foster care, updates, and other communication from the foster care department

• You may be subject to a background check

Contact Information

First Name:

Last Name:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

OK to call me here

Work phone:

OK to call me here

Cell phone:

OK to call me here

Email address:

Date of birth:

Age:

I live within 30 minutes of NHS:

Do you live in a:

* Have you ever fostered with NHS?:

Yes

Landlord or Leasing Agent

Please complete if you rent.

First name:

Last name:

Name of Complex:

Office phone:

Foster Caregiver History

Have you, a family member, or any person living in the home where the animal will be fostered ever been convicted of any animal related misdemeanor or felony offense?

If yes, please explain.

Foster Home Information

Please note, to foster kittens and/or adult cats you must have a separate room in which to keep them.

Do you have a fenced yard?:

If yes, what type and how high?:

Do you have a separate room for cats?:

Yes

If yes, describe the location and type of flooring.

Demographic Information

Please list the number of adults in the home and their names. If you have children, or children that visit the often such as grandchildren, please list the number of children and their birth year.

Preferences

Please select below the animals you may be interested in fostering.

Are you interested in a certain animal?

Please name the animal and how you heard about them.

Availability

What is your availability for fostering?

Resident Animals

Please list all current animals living in your home. Provide name, breed, age, sex, and if spayed/neutered

Veterinarian

Please provide your veterinarian’s name, practice name and phone number. We will contact them to verify that your animals are current on their vaccinations.

First name:

Last name:

Name of Practice:

Office phone:

Waiver of Liability

I, the undersigned, acknowledge my desire to provide a foster home for the animal detailed above (the “Foster Animal”) which are owned and/or for which the Nebraska Humane Society (the "NHS") is entrusted with caring for. I understand by executing this Agreement that the NHS is granting me permission to keep, protect, feed, and care for the Foster Animal, and I attest that I have the requisite experience and expertise, and that I am knowledgeable in handling and care of the particular animal(s) entrusted in my care.

I understand that there are inherent risks associated with handling and caring for the Foster Animal, including, but not limited to, the risk of personal injury resulting from animal bites, scratches, medical conditions, or disease. With such understanding, I agree for myself, my heirs, personal representatives and assigns, to waive, release and forever discharge the NHS and any affiliated entity, managers, directors, agents, officers, employees, volunteers, or trainer of the NHS (“Releasees”), from any and all claims, demands, losses or damages relating to any injury, to me, my property, and any other third party or their property, including, but not limited to, death or injury caused or alleged to be caused, in whole or in part, by my actions or the actions of the Releasees, unless caused by Releasees willful or gross negligence.

Furthermore, I agree for myself, my heirs, personal representatives and assigns, to indemnify and hold harmless the NHS from any loss, claims, action, causes of action, or proceedings of any kind which may be initiated by myself or any other person or organization as a result of any damage or injury caused by the Foster Animal, including demands, judgments, costs, loss of services, expenses, or reimbursement of reasonable attorney's fees.

By providing a foster home for the Foster Animal in my care, I understand that their stay in my home is temporary, and I will return the Foster Animal to the NHS Foster Care Coordinator upon request by the NHS. Should I wish to permanently keep any animals from the Nebraska Humane Society who are temporarily staying in my home as a Foster Animal, I agree to go through the NHS adoption procedure as designated by NHS’s policy on adopting animals. I understand and agree that the foster care of the Foster Animal does not create a property right in that animal, and the Foster Animal may be removed at any time by the NHS, with or without cause. I understand I will not take the Foster Animal to another veterinary office without permission from authorized personnel. Furthermore, I agree that I will pay for any unauthorized veterinary care and/or additional supplies deemed unnecessary by the NHS. If there is a medical emergency, I will follow the protocol attached to this Agreement.

I have read this Agreement, and understand that by signing it I give up substantial rights that I would otherwise have to recover damages for loss occasioned by the actions, including negligence of Releasees, and sign it voluntarily and without inducement.

I Agree