Foster Care Provider Contract

(Fields with a red asterisk are required.)

Applicant info

Please use the following format 248-555-1212
Please enter correctly as this is the main way we will contact you

Environment info


Please list names and email addresses and phone numbers for three personal references, other than relatives. If you’ve had pets, include references who know the pets you have or have had, and the care that you provide for your pets:

Closing Questions & Statements

I am okay with the FCHS inspecting my home prior to approving me as a foster parent.

I understand that I do not have the authority to give, transfer, or adopt out custody of any foster pet to any other person or organization; unless approved by FCHS.

I understand that the FCHS is the sole and rightful owner of the foster pet. All decisions regarding any and all foster pets are to be made by FCHS.

I agree to only use food, treats, preventatives, toys, etc. that FCHS provides. I will never give a foster pet unapproved toys, food, treats, or medicine unless I speak to a FCHS volunteer and given permission to do so.

I agree to incorporate my foster pet into my daily routine; and to crate and leash train, housebreak, give medication (as directed by FCHS), socialize and work through any behavioral problems including but not restricted to appropriate obedience.

I agree to send photos of my foster pet in home situations and keep FCHS up to date (at least weekly) with updates regarding my foster pet. I understand this is vital information I can share which will help get my foster pet adopted.

I will not contact an adopter without their explicit permission and FCHS knowledge.

I agree to be available to take my foster pet to vet appointments, or make prior arrangements with FCHS to provide transport if I cannot.

I agree, if my schedule allows, and given appropriate notice, to take my foster pet to adoption events when requested by FCHS.

I agree to contact FCHS if I am running low on any food, medications, or preventatives prior to running out.

I agree to keep accurate records when giving any medications or preventatives on the medical sheet given, and give that information to FCHS when requested.

I agree to immediately call FCHS if my foster pet shows signs of illness, e.g., vomiting, diarrhea, lethargy.

I understand when approved as a foster care provider, my first year of membership dues are waived. If I would like to continue fostering for FCHS after that time period, I agree to pay membership dues annually.

Code of Conduct for Floyd County Humane Society Volunteers and Fosters

The Floyd County Humane Society is a 501(c)3 nonprofit organization whose mission is to advocate and provide for the welfare, protection, and humane treatment of companion animals in Floyd County, VA.

This Code of Conduct asks that all volunteers: Represent the Floyd County Humane Society in a polite and professional manner. Share and promote the culture, purpose, and objectives of Floyd County Humane Society. Demonstrate respect and kindness in all interactions towards our animals, clients, donors, and other volunteers. Be prepared and ready to work to an acceptable standard. Treat each other with courtesy, sensitivity, tact, consideration, and humility, in accordance with social norms. Always share feedback or concerns in a respectful manner. Value our role in ensuring the safety of each other, the animals, and the community. Treat new volunteers in a responsible, patient, and motivational manner. Recognize and congratulate the achievements of others. Endeavor to balance organizational and individual needs. Follow all Floyd County Humane Society procedures and protocols as well as instruction given by trainers and supervisory personnel. Promote healthy and safe work practices during volunteer projects and training.

Causes for Reprimand: Handling an animal in a manner contrary to the training you have received. Mishandling may include, but is not limited to, the following: not using provided equipment for dogs, using punishment, and providing an unsafe environment for the animals. Incivility to volunteers and the public. We pride ourselves on having an inclusive, compassionate community whose care extends not only to the animals but also the people within our community. Not showing up for a shift that you signed up for, without proper communication. Although someone may give you direction, this is not considered a cause for reprimand. Reprimands are private, sit down conversations with a committee member. Being reprimanded can lead to retraining or removal from a specific program.

Termination: Violation of any Floyd County Humane Society agreement. Any criminal activity on our property. The mistreatment of volunteers deemed to threaten the compassion and trust within our community. Any animal cruelty.

I, (name shown above), recognizing the important responsibility I am undertaking in serving as a volunteer of the Floyd County Humane Society, hereby pledge to carry out in a trustworthy and diligent manner the duties and obligations associated with my role as a volunteer and abide by this Code of Conduct. I understand that failure to abide by this Code of Conduct may result in my reassignment or removal as a volunteer, pursuant to the requirements and processes provided in the organization’s governing documents.

Waiver of Liability & Hold Harmless Agreement for FCHS Volunteers and Fosters

1) In consideration for receiving permission to participate in Floyd County Humane Society activities and the Floyd County Animal Shelter, I hereby release, waive, discharge and covenant not to sue the Floyd County Humane Society or the County of Floyd, Virginia, their officers and agents (hereinafter referred to as releasees) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or any of the property belonging to me, whether caused by the negligence of the releasees, or otherwise, while participating in such activity, or while in, on or upon the premises where the activity is being conducted.

2) I am fully aware of the risks involved and hazards connected with such activities, including but not limited to injuries due to dog or cat bites or scratches, and I am fully aware that there may be risks and hazards unknown to me connected with such activities, and I hereby elect to voluntarily participate in said activity with full knowledge that said activity may be hazardous to me and my property. I voluntarily assume full responsibility for any risks of loss, property damage or personal injury, including death, that may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in such an activity, whether caused by the negligence of releasees or otherwise.

3) I further hereby agree to indemnify and hold harmless the releasees from any loss, liability, damage or costs, including court costs and attorney fees, that they may incur due to my participation in said activity, whether caused by negligence of releasees or otherwise.

4) It is my express intent that this Waiver of Liability and Hold Harmless Agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a Release, Waiver, Discharge and Covenant Not to Sue the above named releasees.

5) In signing this release, I certify that I have never been convicted of animal cruelty, neglect, or abandonment.

6) In signing this release, I acknowledge and represent that I have read the foregoing Waiver of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this release for full, adequate and complete consideration fully intending to be bound by the same.

The Floyd County Humane Society (FCHS) may limit the number of foster animals per foster home as they see fit. Foster animals are not to be placed into a home without the approval of the Foster Committee. If at any time an animal is not working out in your home, you may return it to the FCHS, but we ask that you contact a member of the Foster Committee prior to doing so. If possible, the FCHS will place the animal into a different foster home or find a solution to whatever is occurring within your home, without having to remove the animal. The Floyd County Humane Society, its Board of Directors, and all other members or volunteers associated with the organization are not liable for any injuries to you or other persons living or visiting your home, damage to any personal property, or unnecessary veterinarian bills accrued while the animal is within your care. By signing this document, you are verifying that you have read and agree to the above paragraphs.

Updated September 2022