United States Equine Sanctuary & Rescue
Foster Care Provider
Non-member
Registration
I, __________________________________ am applying to become an approved Foster Care Provider for the United States Equine Sanctuary & Rescue. I understand that all equine, which I foster, shall remain the sole property of the United States Equine Sanctuary & Rescue until such a time as they are legally adopted by myself or someone else.
My personal information, for identification verification purposes is as follows:
**The initials “FCP” shall hereby refer to “Foster Care Provider”.
FCP Full Legal Name: ___________________________________________________
Name most people call you: _______________________________________________
Current Address: _______________________________________________________
Length of Tim at this Address: _____________________________________________
Previous Address (if at present address less than 5 years) _________________________
_____________________________________________________________________
Do you (circle one) Own? Rent? Live with relatives?
Do you live in a (circle one) House? Apartment? Condo? Mobile Home? RV? Other?
Your e-mail address & website address (URL): ________________________________
_____________________________________________________________________
Home Phone Number: ____________________________________________________
Cell Phone Number: ______________________________________________________
Work Phone Number: ____________________________________________________
Place of Employment: _____________________________________________________
Length of time at current job: _______________________________________________
Yearly (annual) Income Range (please count only the income that will be used to care for the foster equine; for example: if you and your spouse do not mix your income) (circle one):
$5,000.- $15,000. $15,001. - $30,000. $30,001. - $50,000. $50,001 - $80,000.
$80,001. - $120,000. Over $120,000.
Are you married or single? _______________________________________________
If married, what is your spouse’s full name? ____________________________________
Where does your spouse work? (name of employer, city of employment)
_____________________________________________________________________
Please describe the conditions you plan to keep your fostered equine in by answering the following questions:
Where will you be keeping your fostered equine? (circle one) Boarding Facility
Your Home At a friend’s home At a relative’s home On land you lease
Other: ______________________________________________________________
Do you own a truck that can pull a horse trailer? If yes, what kind of truck do you own (or are buying)?
Make: _____________ Model: ______________ License Number: ______________
Do you own a horse trailer? If yes, please describe it:
___________________________________________________________________
Please tell us about all of the animals you currently own or are fostering:
Total Number of Animals Owned/Fostered (not including USESR equine): ___________
Breakdown of species, by number. Include livestock, poultry, house pets, exotics, etc.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Personal References.
Please give us the name, address, and phone number of three relatives.
#1: __________________________________________________________________
#2: __________________________________________________________________
#3: __________________________________________________________________
Please give us the name of your immediate supervisor, if you are employed:
_____________________________________________________________________
Please give us the name, address, and phone number of three people who are not related to you. These can be neighbors, co-workers, or friends. They must be people who have been to your home and can attest to how well you treat your animals.
#1: __________________________________________________________________
#2: __________________________________________________________________
#3: __________________________________________________________________
This completes the registration process. You will be notified when we receive your application, as we will contact you to arrange a Site Inspection. If you have not received a response to this registration within 7 days, please contact USESR Headquarters at 877-720-1685 or e-mail headquarters@usesr.org. Registration does not take the place of a Foster Care Contract.
Print this application & mail to: (no money is required; you need not be a dues-paying member to foster)
USESR
P.O. Box 565, Bridgeport, TX 76426
Registration must be accompanied by a copy of FCP’s current drivers license or state-issued I.D. card, proof of income (copy of current payroll check, copy of income tax returns with sensitive information blacked out, etc.), and a copy of a recent utility bill to provide proof of residency.
