Foster Carer Application Form 2012

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FOSTER CARER APPLICATION
Name: ...................................................... Title: .......................................... Post Code: ...................................
Address: ...............................................................................................................................................................
Town: ...................................................................................................... County: …….........................................
Tel No. Home: ......................................... Work: ....................................... Mobile: ............................................
E-mail: ................................................................. Please tick box if preferred not to be contacted by e-mail 
Telephone:
Day …………………………………
Evening ………………………………. Mobile ……………………..………….
Work ………………………………………………….. Can you be contacted at work? Yes / No
Applicant’s Occupation …………………………….............................…… Hours of work …………..........................………
Partner’s Occupation ……………………….................................…… Hours of work ................................................…
Will the animal be left at home alone and if so when?
Morning …................….. hours
Afternoon ..................…….. hours
Evening …..................….. hours
What facilities can you provide for the animal whilst you are at work?
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Is your home:
House
Bungalow
Flat
Situated in:
Town
Suburbs
Village
Country
Is it secure?
Yes / No
Do you have a garden?
Yes / No
Is your garden?
Private
Communal
What is the height of fence/wall at its lowest point? …..........................................................……….............….
Do you drive? Yes / No
Do you own a car?
Yes / No
Are you able to travel to Raystede for check-ups, introductions and socialising?
Yes / No
What are your reasons for wanting to foster?
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How long are you able to foster for?
1 – 2 months
2 – 4 months
4 – 6 months
6 months +
What kind of animals would you like to foster?
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Are there any breeds of dog that you would not consider fostering?
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Are there any breeds that you have experience with and what type of experience do you have?
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What experience do you have for caring for pet animals?
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What qualities do you have that you feel would be important to being a good pet fosterer?
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How many pets do you currently own and what are they?
Type: …….......…...………
Type: …….......…...………
Breed: …..…......…..……..
Breed: …..…......…..……..
Age: ………..........…….
Age: ………..........…….
Sex ……...….…...…...
Sex ……...….…...…...
Vaccinated?
Yes / No
Neutered?
Yes / No
Page 2 of 5
Raystede Centre for Animal Welfare, The Broyle, Ringmer, East Sussex, BN8 5AJ.
Tel: (01825) 880478 Fax: (01825) 840995 E-mail: petfostering@raystede.org www.raystede.org
Chief Executive: Nigel Mason.
President: Morgan Williams.
Registered Charity No. 237696. Registered Office: Raystede, Ringmer, East Sussex, BN8 5AJ. Registered in England No. 816674
What other members are there in your household? If there are children, please list their ages?
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Do you have any regular visitors to the house? If so who are they, how old are they and how often do they
visit?
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Do you have any animals that visit regularly? If so what are they and how often do they visit?
Are they dog friendly?
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Sometimes pets from families where there is domestic violence can be traumatised which can cause
behavioural problems. Some of the problems that can occur are listed below, please describe how you
would deal with these situations should they occur?
1. An animal that constantly wets and soils in the house?
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2. Furniture and personal belongings being chewed / scratched?
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3. An animal that howls/cries when left alone?
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How would you feel about giving the animal back after fostering it for what may be a few months?
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Page 3 of 5
Raystede Centre for Animal Welfare, The Broyle, Ringmer, East Sussex, BN8 5AJ.
Tel: (01825) 880478 Fax: (01825) 840995 E-mail: petfostering@raystede.org www.raystede.org
Chief Executive: Nigel Mason.
President: Morgan Williams.
Registered Charity No. 237696. Registered Office: Raystede, Ringmer, East Sussex, BN8 5AJ. Registered in England No. 816674
Please add further information you feel may be of interest to us in regard to pet fostering:
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Do you live in rented accommodation?
Yes / No
If yes, do you have permission for pets? Yes / No (please provide written evidence)
Where did you hear about the pet fostering scheme?
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Declaration
I confirm that all the information supplied on this application form is true and correct to the best of my
knowledge.
I understand that the information given on this form will be stored in manual and electronic files and is
subject to the provision of the Data Protection Act 1998. I agree to the information provided on this form
being used by the Raystede in accordance with the Act and, in particular, for equal opportunities
monitoring.
Name ………………………………………………………………………..……………………………………………..…………………………………..
Signature ………………………......……………….……..
Date
……………………………………………….……………..
All volunteers are asked to supply two references (no family members please). Please give details on the
below.
REFERENCES
1.
Name …………………………………………..…...
Address
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………………………………………..……………….…….
……………………………………………………..….…….
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2. Name …………………………………………………...
Address
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Page 4 of 5
Raystede Centre for Animal Welfare, The Broyle, Ringmer, East Sussex, BN8 5AJ.
Tel: (01825) 880478 Fax: (01825) 840995 E-mail: petfostering@raystede.org www.raystede.org
Chief Executive: Nigel Mason.
President: Morgan Williams.
Registered Charity No. 237696. Registered Office: Raystede, Ringmer, East Sussex, BN8 5AJ. Registered in England No. 816674
If you feel you are not able to foster a pet yourself but would like to volunteer to support the scheme in
other ways e.g. supporting fosterers, transporting food or fundraising? Yes / No
Please give further information of how you would like to support us: ……………………………………………………………
Please return this form to Emma Ham, PO Box 224, Lewes, BN7 9HW
or
Email: petfostering@raystede.org
Office use only
References applied for?
Yes / No
(delete as appropriate)
Permission sought?
Yes / No / n/a
(delete as appropriate)
Able to transport pet?
Yes / No
(delete as appropriate)
No of pets able to take?
□ Single
□ Pair
Type of cat?
□ Indoor
□ Outdoor
Home visit date
……./..……/…….
Approved Yes / No
No – reason why
□ Family
(delete as appropriate)
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Page 5 of 5
Raystede Centre for Animal Welfare, The Broyle, Ringmer, East Sussex, BN8 5AJ.
Tel: (01825) 880478 Fax: (01825) 840995 E-mail: petfostering@raystede.org www.raystede.org
Chief Executive: Nigel Mason.
President: Morgan Williams.
Registered Charity No. 237696. Registered Office: Raystede, Ringmer, East Sussex, BN8 5AJ. Registered in England No. 816674
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