All new fosters are required to complete this survey, attend a volunteer orientation, and must live within 15 minutes of Bloomington/Normal. All animals are required to be at all adoption events each weekend. Name* First Last Birth Date* Date Format: MM slash DD slash YYYY Are you able to ensure your foster will be at all adoption events on the weekends?*YesNoIf no, please explain*Do you live within 15-minutes of Bloomington/Normal?*YesNoRequired 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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country If you currently rent your home, does your landlord/rental agency allow pets?*YesNoI own my homePhone Number*Best number to reach you.Email* Enter Email Confirm Email What is your preferred method of communication?*TextCallE-MailEmployment:*EmployedRetiredOtherName your workplace:*Please Explain:*Please list any previous foster experience:*Do you currently foster for another animal welfare organization?*YesNoIf yes, who?*Do you have any disabilities that need to be accommodated?*YesNoIf yes, please explain:*Do you own any pets?*Dog(s)Cat(s)Horse(s)Rabbit(s)Bird(s)OtherNone at this timePlease 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?*YesYes, with guidance/trainingNoDo 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?*YesNoIf yes, please explain:*In case of emergency, please contact:* First Last Emergency Contact Phone:*Waiver and Release of Liability*Click here after reading WaiverI have read and agree to the Waiver and Release of LiabilityWaiver 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?*Friends or FamilyOur WebsiteChurchSchoolSocial MediaVolunteer MatchSocial Service AgencyPetfinderOtherPlease enter anything else you might want us to know about yourself: