Holiday Breakout Application

Thank you for your interest in our Holiday Breakout!
This is a special time of year for our shelter dogs as they have the chance to have a break from the kennel environment.
Please note that all applications must pass a background check, property check, and vet check.

For questions or more information, please call 217.223.8786 or email 

Home For The Holidays

Applicant Information

Applicant #1
Date of Birth(Required)
Applicant #2
(if applicable)
Date of Birth
(if applicable)
(if applicable)
Do you:(Required)
I/We live in:(Required)

Pet Ownership

Do you currently have any pets?(Required)

Home Life

Do you have a yard?(Required)
If you have a fence, what is your vertical fence height?(Required)
Please take time to think and be honest when answering the following. What are you absolutely NOT willing to deal with during the home visit?(Required)

Required Acknowledgement

I certify that the above information is true and correct. I understand that any falsification of the above information may be grounds for the denial of this application. I acknowledge that this application will remain the property of the Quincy Humane Society. During the foster care term, the animal(s) remain the property of the Quincy Humane Society, and all decisions pertaining to the said animal(s)' welfare and medical needs will be decided by the Quincy Humane Society's Executive Director, Interim Executive Director, or Adoption Manager. The Quincy Humane Society will provide the food and other necessary supplies for the foster animal(s) as requested by the Foster Caretaker.
(if applicable)
Date Signed

Future Fostering Opportunites

Would you be interested in fostering in the future?
Foster Opportunities you'd be interested in (check all that apply):