Lumpkin County, GA

Personal Information

If you are interested in fostering an animal in our Animal Welfare Foster Program please fill out and submit this application. Questions? Email Wayne Marshall, or call the shelter at 706-867-7297
First Name
Last Name
Occupation
Employer
Spouse's First Name
Spouse's Last Name
Spouse's Occupations
Spouse's Employer
Street Address
Address Line 2
City
State/Province/Region
ZIP/Postal Code
Country
Home Phone
Work Phone
Email
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If renting, do you have your landlord's or management company's permission to have pets?
Is there a weight/size/breed restriction?
If yes, please describe.
If you rent, we will need to contact your landlord or property manager.
Landlord/Property Manger First Name
Landlord/Property Manger Last Name
Landlord/Property Manger Phone
Are there any children in your household?
1. Yes
2. No
How many adults live in your household?
1. 1 to 2
2. 3 to 4
3. 5 or more
Is anyone in the household allergic to dogs or cats?
1. Yes
2. No
Does anyone in your household have a fear of dogs or cats?
1. Yes
2. No
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Please provide three references.
Do not list your veterinarian here, and please list no more than one family member. Please include a parent if you are in college.
Reference 1 Name
Reference 1 Phone
Reference 2 Name
Reference 2 Phone
Reference 3 Name
Reference 3 Phone
Veterinarian Name
Veterinarian Phone
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Please provide any animal experience, activities, or any other information you think it would be helpful for us to know about you, your pets, or your family.
I acknowledge that I completely read the questionnaire, comprehend it fully, know that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this contract can result in the forfeiture of any Animal Welfare Foster Program animal adopted by me. I certify that the above information is correct, and I understand that the information will be verified.
1. Yes, I acknowledge.
I understand and agree to release and covenant to hold harmless the Lumpkin County Animal Shelter / Animal Welfare Foster Program, and its members from any claims, damages, cost, or actions incurred as a result of the care or actions of the animal. I accept full responsibility for the animal(s) actions at all times, and release the Lumpkin County Animal Shelter and Animal Welfare Foster Program, from any liabilities or damages that may be incurred as a result of fostering such animal(s). I agree that the Lumpkin County Animal Shelter and Animal Welfare Foster Program is not liable under the concept of charitable immunity
1. I understand and agree.
Photo Identification

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