Foster Application

You must be 18 years of age or older to foster an animal.

Applicant Information
Name: *
Name:
Date of Birth *
Date of Birth
Phone: *
Phone:
Address: *
Address:
Do you have a fenced in yard? *
Do you live near a pool of water or have a pool on site? *
Do you agree to let a member of the Babinski Foundation staff perform a home check, not to judge your home but to see where the animal will be staying? *
Do you rent or own your home? *
If you rent, we must have a signed letter on letterhead from you landlord informing us that it is acceptable to foster an animal at this time.
Landlord's Name:
Landlord's Name:
Landlord's Phone Number:
Landlord's Phone Number:
Do you smoke in your home? *
Emergency Contact Information
This section is for you to put down all of your medical emergency contact information, if you wish to do so. This information will not be used for any other purpose.
Doctor's Name:
Doctor's Name:
Doctor's Phone Number:
Doctor's Phone Number:
Emergency Contact:
Emergency Contact:
Emergency Contact's Number:
Emergency Contact's Number:
References
Please list two non-related references .
First Reference: *
First Reference:
First Reference's Phone Number: *
First Reference's Phone Number:
Second Reference: *
Second Reference:
Second Reference's Phone Number: *
Second Reference's Phone Number:
Additional Information
What species of animals are you interested in fostering? *
Check all that apply
Do you have the knowledge and skills to give vaccinations? *
Do you have the knowledge and skills to bottle feed nursing animals? *
Have you ever whelped litters? *
Include their name, species, and age.
Do you have your own transportation?
Do you have an insured truck or van?
Will the animal be primarily inside or outside? *
Will the animal sleep inside or outside? *
Will you be able to tolerate potty accidents in your home? *
Will your personal animals be in contact with the fostered animals? *
Are there any pregnant animals at your home currently? *
Any juvenile animals at your home? *
Animals under the age of 5 weeks.
If you have any personal animals at your home, are they currently up to date on recommended vaccinations?
(Dogs) Distemper, Parvovirus, Adenovirus 1, Rabies (Cats) Herpes, Calici, Panleukopenia, Feline Leukemia, Rabies
Do you feed them separate or together?
Do you currently have a veterinarian?
Veterinarian's Name:
Veterinarian's Name:
Veterinarian's Phone Number:
Veterinarian's Phone Number:
Disclaimer
I certify that my answers are true and complete to the best of my knowledge. I give permission to the Babinski Foundation to contact my veterinarian, landlord, or any other persons to verify my disclosed information within this survey. I certify that I will be the primary caregiver of any fostered animals. If this application leads to me becoming a volunteer, I understand that false or misleading information in my application may result in my release from the Babinski Foundation. I understand that the Babinski Foundation requires the assistance of volunteers in conducting its various programs. It is my desire to further the work of the Foundation by performing services as a volunteer. I agree to perform these services without compensation, and in performing my services, I acknowledge that I am not acting as an employee of the Foundation. I will not hold the Foundation liable for any personal or property damage I may incur while performing volunteer services. I agree to conform to the Foundation’s policies and procedures while volunteering. I agree to hold all information shared with me while volunteering at the Babinski Foundation in strict confidence.
Volunteer Insurance Waiver
I understand that the Babinski Foundation requires the assistance of volunteers in conducting its various programs. It is my desire to further the work of the Foundation by performing services as a volunteer. I undertake to perform these services without compensation, and in performing my services, I acknowledge that I am not acting as an employee of the Foundation. I will not hold the Foundation liable for any personal or property damage I may incur while performing volunteer services. I agree to conform to the Foundation’s policies and procedures while volunteering. I agree to hold all information shared with me while volunteering at the Babinski Foundation in strict confidence.
Confidentiality Agreement
This confidentiality agreement is required for the protection of the Babinski Foundation and in recognition that employees/volunteers/board members of the Babinski foundation may either acquire or observe documents, or overhear conversations, or information that is private and confidential in nature. Accordingly, the undersigned employee/volunteer/board member agrees that if he or she comes into possession of either written or oral information of any kind about the Babinski Foundation about its employees/volunteers/board members, or clients as the result of employment/volunteer/board work with the Babinski Foundation, the undersigned agrees to keep all such information confidential and not disclose or publish this information to any person unless expressly permitted in writing by the Babinski Foundation executive director. It is acknowledged that this agreement is not only for the protection of the Babinski Foundation and its clients regarding their confidential information but the agreement is also a reminder to the undersigned that inappropriate disclosure of such information by the undersigned could expose the undersigned to liability or claims if the disclosure of such information cause either monetary damage or other irreparable harm to the Babinski Foundation or its clients.
By entering my full name here, I fully agree to the above written disclaimer, Volunteer Insurance Waiver, and Confidentiality Agreement