Foster Application Form
Please complete this application form if you are interested in becoming a Humane Society of Portage County foster care giver. Once you complete the form, click the submit button at the bottom.
Name and address
First name:
*
Last name:
*
Middle name:
Street 1:
*
Street 2:
City:
*
State:
Choose
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
Zip:
*
Home phone:
OK to call me here
Work phone:
OK to call me here
Cell phone:
OK to call me here
Email address:
Spouse's name:
Check if we can send you a text message:
Demographic Information
You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.
Date of birth:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
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1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
*
Gender:
Choose
Female
Male
Education:
Choose
Associate degree
College degree
Doctoral degree
High school
Masters degree
Some college
Trade/Vocational school
T-Shirt size:
Choose
Extra extra Large
Extra Large
Large
Medium
Small
Rent or own?:
Choose
Live with parents
Own
Rent
Do you have transportation?:
Choose
No
Yes
Drivers License Number:
List ages of all children in household:
How often do you travel?:
If you rent, please provide landlord name and contact information.
Residence
Please describe your residence. Check all items that apply.
Fenced in yard:
Secure screens on all windows:
Room available to isolate foster animal:
Other things we should know:
Employer / Employment
Please tell us about your current employment. What are your normal working hours? Do you travel for work?
Employer name:
Other adults in your household
Please tell us about other adults (18 years old or older) living in the household (do not include the applicant name)
1
2
First name:
First name:
Last name:
Last name:
Birthdate:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
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5
6
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Year
2042
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2035
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2032
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1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
Birthdate:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
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11
12
13
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30
31
Year
2042
2041
2040
2039
2038
2037
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
3
4
First name:
First name:
Last name:
Last name:
Birthdate:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
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31
Year
2042
2041
2040
2039
2038
2037
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
Birthdate:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
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29
30
31
Year
2042
2041
2040
2039
2038
2037
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
Current pets
Are all pets spayed/neutered?:
Are all pets current on vaccinations?:
List each pet in your home (name, species, breed, age, sex) How do they react to other animals? How do they react to stressful situations such as change in daily routine?
Vaccination verification
We will need to verify your pet's vaccination status for both your animal and our foster animal's protection. Please provide your veterinarian clinic name and phone number.
Disclosure
Have you ever been convicted of any law violation (except minor traffic violations)? Yes or No
If yes, please provide details.
Please note: Disclosure of a criminal record will not necessarily disqualify you from volunteering for the Humane Society. However, failure to disclose such information may result in disqualification of your application or termination of your volunteer service.
Volunteer Experience
Please describe any volunteer experience you have at HSPC and when you volunteered (month/year).
Availability
My availability is:
Choose
Ongoing
Ongoing, except between these dates
Only between these dates
From:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
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31
Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
to:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
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5
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Year
2022
2023
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2027
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2029
2030
2031
2032
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