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2. Name (First, Middle Initial, and Last)*
4. Date of Birth*
5. Email Address*
7. Phone Numbers:
9. Cell*
10. Work*
11. Home
13. Address1*
15. Address2
17. City*
18. State*
19. Zip*
21. County*
23. Is this address (please check one):*

    1. Permanent

    1. Seasonal
25. Do you (please check one):

    1. Own

    1. Rent
27. If you rent, do you have permission from your landlord to foster?

    1. Yes

    1. No

    1. Unsure
29. If yes, please provide your landlord's name and phone number below
31. Name*
32. Phone Number*
34. Foster families must be able to provide transportation for fostered animals to scheduled and emergency vet appointments. Do you possess a valid driver's license?*

    1. Yes

    1. No
36. If there are children living in your household, what are their ages?*
38. Number of intact animals in the home, including species (Iowa Department of Agriculture and Land Stewardship does not permit us to foster out intact animals into a home where there is a sexually intact animal of the opposite sex of the same species):*
40. Do you currently have pets?*

    1. Yes

    1. No
42. Total number of:
43. Dogs
44. Cats
45. Other
47. Are they current on their rabies vaccination?

    1. Yes

    1. No
49. Are they current on their distemper vaccinations?

    1. Yes

    1. No
51. What veterinarian do you use for your personal pets?
53. Clinic Name
54. Clinic Phone Number
56. Please check any diseases your household pets have or had within the last six months:

    1. Kennel Cough
    2. Distemper
    3. Parvo
    4. Fleas
    5. Internal Parasites
58. Species of animals requesting to foster:
60. Foster Exprience
62. What species of animals are you interested in fostering?
64. Please describe any previous fostering experiences you have.
66. Please describe any other experience(s) you have caring for the species of animal(s) you are interested in fostering:
68. Please describe any other experience you have administering medication to animals:
70. How many hours per day would your foster animal(s) be alone?
72. What type of animal fostering are you interested in?(Please check all that apply)

    1. Moms with babies/Pregnant Mom
    2. Neonatal Kittens/Neonatal Puppies (1-6 weeks old)
    3. Weaned Kittens (over 6 weeks old)
    4. Weaned Puppies (over 6 weeks old)
    5. Special needs - Medical
    6. Special needs - Socialization
    7. Hospice Foster
    8. Give Me A Break (1-4 week break from shelter life)
74. Where will your foster animals be housed?
76. A separate room is required to isolate fosters from any resident pet(s). If no resident pet(s) exist, it’s still important to house them in a small room for the first week of their stay in your home. Do you have a room available for this? *

    1. Yes

    1. No
78. Foster animal(s) require fresh food and water a minimum of two times a day, or more if they are ill or neonatal kittens. Are you able to accommodate this?*

    1. Yes

    1. No
80. Neonatal and orphaned kittens may require feeding every 2-3 hours, including throughout the night. Are you able to accommodate this? (Mark “NO” if you do not wish to foster orphans less than 6 weeks old)

    1. Yes

    1. No
82. Foster animals require exercise and mental stimulation to get them ready for adoption. What plan do you have to exercise/socialize your foster animal(s)?
84. The Iowa Department of Agriculture Land and Stewardship (IDALS) requires all foster oversight organizations to inspect foster homes annually. Our organization performs inspections within 30 days of a foster family’s acceptance into the program, followed by annual inspections. The initial inspection must be performed prior to any animals being placed in the home. The IDALS also reserves the right to inspect foster homes as they deem necessary. Initial:*
86. Foster Families must also have availability to schedule appointments with the shelter’s animal control officers or shelter attendants for biweekly (every other week) medical check in appointments. Initial:*
88. To best accommodate these two needs, please provide your availability below.
90. Monday
92. Tuesday
94. Wednesday
96. Thursday
98. Friday
100. Saturday
102. I agree that my service as a Foster Care Provider are provided on a strictly volunteer basis. I shall receive no pay, benefits, or compensation of any kind from the Story County Animal Shelter for my foster care of animals. I agree to provide foster care in strict compliance with the policies and procedures of the Story County Animal Shelter and The Iowa Department of Agriculture and Land Stewardship Department Iowa Administrative Code Chapter 67 “Animal Welfare”. This includes but is not limited to: i. Provide adequate food, water, shelter, safe containment and humane treatment for the animal(s) at all times. ii. Monitor the animal(s) and provide proper care and socialization to increase their possibility for adoption. iii. All adoptions and euthanasia of animal(s) placed in foster care homes shall be the responsibility of the Story County Animal Shelter and shall not be performed by the foster care home. iv. All emergency medical care must follow the steps laid out in the foster care manual, and is at the discretion of the Story County Animal Shelter. v. All deaths, injuries, or emergency euthanasia occurring within a foster care home or the animal being lost shall be reported to the foster oversight organization within 24 hours of the event. vi. Agree to represent yourself professionally. vii. Agree to return the Story County Animal Shelter foster animal(s) for sterilization on the agreed upon date by the Story County Animal Shelter staff.
104. Please initial to the right of each statement after you have read it.
106. The Story County Animal Shelter reserves the exclusive right to determine the proper course of action to take upon notification by the Foster Care Provider of any inability to comply with this agreement*
108. I understand and agree that the fostered animal(s) are the exclusive property of the Story County Animal Shelter. This Foster Care Agreement transfers no ownership rights.*
110. I understand if any foster animal under my care dies, the body must be returned to the Story County Animal Shelter.*
111. I will respect the Story County Animal Shelter’s decision to determine whether a Foster Care Provider can adopt a foster animal*
113. I fully understand and agree that the ultimate disposition of any animal(s) under this foster care agreement is at the sole discretion of the Story County Animal Shelter*
115. I will agree to vaccinate my own animal(s) against the following diseases before fostering in cases where the Story County Animal Shelter has approved me to socialize my foster animal(s) with my personal pet(s): i. Canines are immunized against Canine Distemper, Canine Parvovirus, Parainfluenza, Hepatitis (4-in1booster), Rabies and are free of parasites. ii. Felines are immunized against Feline Panleukopenia, Rhinotracheitis, Calicivirus (3-in1) and Rabies, and are free of parasites.*
117. I understand no reimbursement by the Story County Animal Shelter will be given to me regarding any expenditure which I incur without prior approval for the care and treatment of the foster animal(s).*
118. I have not been found to have engaged in or participated in an act constituting animal abandonment, neglect, cruelty, or abuse*
120. I have not been ever had a license or permit under Iowa Code chapter 162 or under the United States Department of Agriculture’s animal care program revoked, nor surrendered a license in lieu of revocation*
122. I understand if a fostered animal under my care or my own animal dies from a contagious disease, I will not be considered for fostering other animal(s) of the same species for a specific length of time as deemed suitable by the Story County Animal Shelter. Discussion with a veterinarian will determine the length of time necessary before fostering any animal again in a Foster Care Provider’s home that has been exposed to ta specific disease. The Foster Care Provider will be responsible for appropriately sanitizing all infected area.*
124. While the Story County Animal Shelter encourages Foster Care Providers to share pictures of their foster animals, please be aware: i. You are personally responsible for the content published in any form of social media. Be considerate of the content and be judicious about the information, both personal and professional, that you disclose. Your online presence reflects directly upon the Story County Animal Shelter. ii. I understand that the Story County Animal Shelter will schedule meet and greets with the foster animal(s). iii. Be transparent and honest when communicating or posting materials – always identify yourself and clearly state that any comments or materials that you have posted represent your personal opinion and not that of the Story County Animal Shelter. iv. Do not use Story County Animal Shelter’s intellectual property, logos, trademarks, copyrights or the Company’s name or identity. v. Unless you are an employee, do not speak on or imply that you speak on behalf of the Story County Animal Shelter.*
126. I understand that any breach of the conditions of this foster care agreement may result in immediate termination of this agreement. In that case the Story County Animal Shelter shall take immediate possession of the fostered animal(s).*
128. Indemnity
130. I agree to release, discharge, indemnify and hold harmless the Story County Animal Shelter, including its agents and employees, for any and all personal injuries or damages to property or pets caused by the foster animal(s)*
132. I recognize that in handling foster anima(s) there exists a risk of injury including physical harm caused by a foster animal(s). On behalf of myself, my heirs, personal representatives, and executors, I release, discharge, indemnify and hold harmless the Story County, the Story County Animal Shelter, its agents, volunteers and employees from any and all claims, causes of action or demands, or any nature of cause connected with my foster care agreement.*
134. I understand that public relations are an important part of volunteering in the foster care program. I agree on behalf of myself, my heirs, personal representatives and executors to allow the Story County Animal Shelter to use any photographs taken of me for use of public relations efforts. The Story County Animal Shelter will use reasonable efforts to notify me but such notification is not a condition of its release for public relations purposes.*
136. Signature*
137. Date*
139. If at any time you have questions, please feel free to reach out and connect with us! Phone: 515.382.3338 Email: scasfosters@storycountyiowa.gov Anna Henderson Story County Animal Control Director Phone: 515.382.3338 Email: ahenderson@storycountyiowa.go
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