RPSM Foster Application Full name First name Last name Gender Male Female radiobutton8794 Email address Current address Street address Street address 2 City State Phone numbers Cell Phone Alternate Number Marital Status Single Married Divorced Widowed select5280 Education Level Did not graduate high school Highschool graduate some college 2 Year Degree 4 Year Degree Post Graduate Work Post Graduate Diploma select9587 Household Information Home Status Single Family Home Duplex Condominium Townhouse Mobile Home select4085 Do you have a completely fenced in yard? Yes No radiobutton5736 If so, what kind of fencing? N/A 4' Chain Fence 6' Chain Fence 4' Wooden Privacy Fence 6' Wooden Privacy Fence Underground select4769 How many adults live in your household? 1 2 3 4 5 6+ select4092 Do all the adults work outside the home? Yes No radiobutton1728 Do you have children? Yes No radiobutton2532 If YES what are their ages? Please tell us about your home environment and your neighborhood (i.e. rural, lots of children, senior-citizen neighborhood, dog oriented neighborhood) Why are you interested in fostering an animal for RPSM? Please tell us about your experience caring for animals Would you be willing to care for a rescue animal that has substantial medical issues that require a heavy level of attention? Yes No radiobutton1647 Would you be willing to care for a rescue animal that has behavioral / socialization issues which may require extra attention? Yes No radiobutton9986 How many RPSM dogs are you able to accommodate in your home for fostering? 1 2 3 4 5 select6737 Do any animals currently reside in your home? Yes No radiobutton5630 Pet #1 Name Age & Sex Type Dog Cat Other select2409 Breed (if Dog) Spayed/neutered? Yes No radiobutton7275 Pet #2 Name Age & Sex Type Dog Cat Other select1782 Breed (if Dog) Spayed/neutered? Yes No radiobutton3405 Pet #3 Name Age & Sex Type Dog Cat Other select1842 Breed (if Dog) Spayed/neutered? Yes No radiobutton3110 Pet #4 Name Age & Sex Type Dog Cat Other select3190 Breed (if Dog) Spayed/neutered? Yes No radiobutton1423 Please indicate the ages, types and typical behavior of any additional animals currently residing in your home. Please provide RPSM with the name, phone number, address, and email address(if known) for your current veterinarian. If you do not have one, please enter N/A. Please provide RPSM with two (2) personal references who can speak to your experience caring for animals. We require name, address, phone number, email and their relationship to you. Is there a particular type dog that you are interested in fostering? Also are there any types or breeds that you are unwilling to foster? How did you hear about RPSM? Personal Reference Facebook Twitter Internet Search PetFinder Adopt-A-Pet Adoption Event Fundraising Event Other select7956 Foster Release As a member of RPSM, I pledge the following: 1. To abide by the by-laws and operating procedures of RPSM. 2. To conduct any activities related to RPSM in a volunteer capacity, receiving no compensation or substantial personal gift for it. 3. To educate potential adopters, the general public and current pet owners about issues regarding spay and neuter, I.D., temperament, health, training, care, etc. 4. To complete any RPSM volunteer activities as promptly as possible and to promptly notify RPSM leadership if unable to complete a volunteer activity. 5. To conduct myself in a courteous manner in all facets of RPSM work such that my behavior brings credit to the image of RPSM and animal rescue in general. 6. To support the spay/neuter policies of RPSM and attempt to educate the public as to the importance of spaying and neutering. I have read and fully understand the above Code of Ethics and the Bylaws of Refurbished Pets of Southern Michigan. I understand that a breach of these may result in my removal as a volunteer in good standing. I agree checkbox1321 If you would like to be considered as a possible foster family for one of our rescued pets, please sign and date below: I HERE BY ACCEPT RESPONSIBILITY FOR ANY/ALL ILLNESS THAT CAN OCCUR FROM A TEMPORARY CARE ANIMAL. I RELEASE REFURBISHED PETS OF SOUTHERN MICHIGAN FROM ANY AND ALL LIABILITY, NOW AND IN THE FUTURE, FROM MY VOLUNTARY ACTION OF CARING FOR ANY REFURBISHED PETS OF SOUTHERN MICHIGAN ANIMAL. Full Name (it will be considered a legal digital signature) Full Name Date Submit button ‹ › × × ×
