Foster Field Trips Application

How did you hear about us?

Your Name(Required)

First Last

Your Address(Required)

Street Address Address Line 2 City ZIP Code

Emergency Contact Information(Required)

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Valid Driver's License Number(Required)

Date of Birth(Required)

Are you a current HSMSC volunteer? (Yes/No)

(*HSMSC will do our best to work with fosters who wish to adopt their foster pets, however, fosters are required to submit an adoption application for approval by the adoptions department. I acknowledge that this application is for foster field trip pets only and is not considered an adoption or foster application. *)

What date/time do you plan to pick up? (Pickup and dropoff are between 11am and 4:30pm)

** If you want to keep a dog longer than a day you must submit a foster application in advance**

8. Do you have limitations as to which dog you’d be willing to take? (For example, is size or energy level a concern?)

What dog are you interested in? (We can't guarantee that your first choice will be available.)

1. Will the dog or puppy be around children under the age of 18? (If Yes, what are their ages?)

Foster Field Trip Agreement and Release (Please initial)(Required)

I understand that volunteering with the Humane Society of Memphis & Shelby County, hereby referred to as HSMSC, may require me to come in contact with animals, and that there are risks associated with my volunteer activities, including but not limited to dog bites and/or scratches. I assume the risks and accept personal liability for any damages that might occur as a result of my volunteer activities. I hereby irrevocably release HSMSC, and (2) its officers, directors, employees, agents, and volunteers (collectively referred to as “released parties”) from any and all claims I may have, or which may hereafter accrue to me, against released parties for personal injury, including death, and all property damage or loss, arising out of my volunteer activity with HSMSC.* I hereby agree to indemnify, defend and hold the Released Parties harmless from any and all liability, losses, damages, judgments, or expenses, including attorneys’ fees, that the Released Parties may sustain in connection with any third party claims that arise out of my volunteer activities, whether such volunteer activities occur on HSMSC'S premises, at my home, or elsewhere.* I understand that HSMSC does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance of any nature in the event of my injury, illness, or death, or damage to or loss of my property. I understand that HSMSC does not provide workers compensation insurance for volunteers. And hereby expressly waiver any claim for compensation or liability on the part of HSMSC in the event of any injury or medical expense.* I agree that if I volunteer to transport any HSMSC animal(s) in my personal vehicle for any purpose, I will 1) maintain at least the state-required minimum amounts of automobile insurance on the vehicle, and 2) release, indemnify and hold the Released Parties harmless from any claims arising from and/or related in any way to such animal’s presence in my vehicle.* I acknowledge and understand that I am a volunteer of HSMSC. I am not eligible for HSMSC’s Workers’ Compensation or any other type of compensation or employee benefit in connection with my volunteer activities.* I understand that the HSMSC may visit my home at any time to review the state and health of this animal. If this contract is broken in any way the HSMSC may confiscate the animal. (initial) By using the HSMSC tags or the #dogventure #doggydayout #hsmscfoster or #hsmscdv hashtags in the images and other content I post on my social media accounts related to my volunteer activities, I hereby grant HSMSC a non-exclusive, fully paid, worldwide, perpetual license to use, modify, publicly perform, publicly display, and reproduce my photographs, name, and likeness solely for marketing and promotional purposes.

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