Foster Application, Pet Central

Name*

First Last

Birth Date*

Are you able to ensure your foster will be at all adoption events on the weekends?*

Yes
No

If no, please explain*

Do you live within 15-minutes of Bloomington/Normal?*

Yes
No

Required due to medical concerns in case animals need to be brought to us.

Address*

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

If you currently rent your home, does your landlord/rental agency allow pets?*

Yes
No
I own my home

Phone Number*

Best number to reach you.

Email*

Enter Email Confirm Email

What is your preferred method of communication?*

Text
Call
E-Mail

Employment:*

Employed
Retired
Other

Name your workplace:*

Please Explain:*

Please list any previous foster experience:*

Do you currently foster for another animal welfare organization?*

Yes
No

If yes, who?*

Do you have any disabilities that need to be accommodated?*

Yes
No

If yes, please explain:*

Do you own any pets?*

Please select all that apply.

If you marked that you own pets, how many of each?*

Describe any experience you have working with animals?*

Are you comfortable caring for an animal that has special needs?*

Yes
Yes, with guidance/training
No

Do you have any specific requirements regarding the kind of animal you will foster? (ex- male, female, weight requirement, age, etc.)*

Have you been convicted of a felony within the last 7 years?*

Yes
No

If yes, please explain:*

In case of emergency, please contact:*

First Last

Emergency Contact Phone:*

Waiver and Release of Liability*

Waiver and Relase of Liability:Waiver and Release of Liability, Indemnification and Hold Harmless Agreement This waiver and release of liability, indemnification and hold harmless agreement is between the Volunteer and Pet Central Helps, 360 Wylie Drive, Normal, IL 61761, McLean County, IL and its directors, officers, employees, agents, assigns, legal representatives and successors (hereinafter referred to as PCH). As a volunteer that is 18 years old or older, I hereby understand and agree to the following: I agree to WAIVE and RELEASE the PCH from all liability, manner of actions, causes of action, debts, contracts, claims and demands for or by reason of any illness, death, damage, loss or injury to person and property, which has been or may be sustained as a direct or indirect consequence of the Volunteer's volunteering at or for the PCH and notwithstanding that such damage, death, illness, loss or injury may have been caused partly by the negligence of the PCH. I agree to INDEMNIFY and HOLD HARMLESS the PCH for any costs or liabilities which they may incur as a result of my volunteering at or for the PCH. I hereby give the PCH the unrestricted right and permission to copyright and use, re-use, publish, and republish photographic pictures of me and my pet, or in which I may be included intact or in part, composite or distorted in character or form, without restriction as to changes or transformations, or reproduction hereof in color or otherwise, made through any and all media now or hereafter known for illustration, art, promotion, advertising, trade or any other purpose whatsoever. I acknowledge and agree that I have carefully read this Agreement, that I fully understand the same, and that I freely and voluntarily execute the same. I understand that I may seek independent advice prior to signing this Agreement. I understand that this Agreement is binding on me, my spouse, my executors, administrators, personal representatives and assigns and that this Agreement has important legal consequences. The terms of this Agreement are contractual and non mere recitals. This Agreement will be construed in accordance with and governed by the laws of the State of Illinois.

How did you hear about us?*

Please enter anything else you might want us to know about yourself:

While our facility is under construction, all pets are in foster care. There are no pets available for viewing at our office. Interested in one of our pets? Please fill out the brief adopter survey and we will get back to you in three business days or less!

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