Kanawha-Charleston Humane Association

Name *

First Name

Last Name

Address *

Street Address

Address Line 2

City

State / Province / Region

Zip / Postal Code

Home Phone *

Area Code

Phone Number

Cell Phone

Area Code

Phone Number

Email *

Current Employer/Occupation *

Tell us about yourself

Please describe why you’re interested in fostering for KCHA: *

Do you have any experience, past or present, fostering animals? *

If yes, please describe:

Tell us about your home

Type of residence: *

House
Apartment

Do you: *

Own
Rent
Live with Parents
Other

If you rent or live in an apartment, does your landlord allow pets? *

Name of landlord *

Phone *

Area Code

Phone Number

(By providing this information you are allowing KCHA to contact your landlord. Please inform them of this call so they will be prepared to speak with us. Thank you!)

Please describe your yard: *

Tell us about your current pet(s)

Number of Pets Owned *

Please Explain: *

Pet (1) *

Name *

Breed *

Age *

Spayed/Neutered *

Up To Date on Vaccinations? *

How long have you had this pet? *

Does this pet have any known issues with other animals, including gender preference or dominance, dog/cat intolerance, etc.? *

Tell us about your family:

Please list every member of your household, including names, ages and their relationship to you: *

Have you discussed what impact your additional foster care responsibilities could have one your family life? *

Please describe your household: *

Active
Noisy
Quiet
Average

How many hours per day will the animal be unattended? *

Have you ever had a dog positive for Parvo in your house? *

I am interested in fostering: (check all that apply)

Tell us about your vet:

Do you have a regular veterinarian? *

Vet’s name *

First Name

Last Name

Clinic Address *

Street Address

Address Line 2

City

State / Province / Region

Zip / Postal Code

Clinic Phone *

Area Code

Phone Number