Foster Application

Name:*
First Middle Last
Birthdate:*
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone*
Email*
Do you rent your home?*
- Yes
- No
If yes, please provide contact information for the property owner:
Number of Adults in your household?*
Information for each adult (18y or older)*

Please list the name (first, middle, last) and birthdate for each individual 18y or older in home
Number of Children in your household and Ages?*
Who will be the primary caretaker of the foster animal(s)?*
Please list all pets currently living in your household
We ask that your current pets are up to date on their vaccines prior to taking home a foster animal. If requested, would you be able to provide us with vaccine records to keep on file at QHS?*
- Yes
- No
- I do not currently own any animals.
Do your current dogs/cats get along with other dogs/cats?*
- Yes
- No
- Unsure
- I do not currently own any animals.
Are your animals spayed/neutered*
If your pet(s) are not spayed/neutered please explain below:
Please describe where you will keep your foster animal(s) when you are home/not home?*
Where will your foster animal(s) sleep at night?*
How many hours per day will your foster animal(s) be left alone?*
What would you describe as unacceptable behaviors in your foster animal (i.e. Growling/hissing, excessive barking, not housetrained, etc.)?*
What would you do if your foster animal(s) displayed any of those behaviors?*
Under what circumstances would you return your foster animal? (Please describe):*
For what length of time are you willing to foster?
- 2 Weeks
- 1-2 months
- Until adopted
Select all that apply
Are you willing to foster an animal with behavior challenges?*
- Yes
- No
- Maybe
What types of behavior challenges do you feel you are able to work with?*
Are you willing to foster an animal with special medical needs?*
- Yes
- No
- Maybe
Please describe any previous experience or training you’ve had working with animals:*
Which of the following special populations are you interested in fostering? Please check all that apply:*
- Select All
- Adult Cats (Sick or injured)
- Mother with kittens
- Orphaned Kittens
- Cat or Kitten Socialization
- Cat/Kitten in need of 10 day quarantine
- Ringworm kittens
- Adult Dog (Sick or injured)
- Mother with puppies
- Orphaned puppies
- Socialization Dog or puppy
- Dog/puppy in need of 10 day quarantine
Signature*
Date*
MM slash DD slash YYYY
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Hours of Operation

Monday 11:30 - 5:00
Tuesday 11:30 - 5:00
Wednesday 11:30 - 5:00
Thursday 11:30 - 5:00
Friday 11:30 - 5:00
Saturday 11:30 - 5:00
Sunday CLOSED

Phone

(217) 223-8786
Fax: (217) 223-9471

Location

1705 N. 36th St.
Quincy, IL 62305

Mailing Address

PO Box 3173
Quincy, IL 62305

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