Name___________________________________________ Age___________________
Spouse’s Name___________________________________ Age____________________
Address_________________________________________________________________
City____________________________ State_____________________ Zip___________
E-mail Address___________________________________________________________
Home Phone____________________________ Cell Phone _______________________
Employer__________________________________ Phone________________________
Spouse’s Employer_____________________________ Phone_____________________
Number of children living at home_____________ Ages__________________________
Other than immediate family, list all living in your home and their ages______________
_______________________________________________________________________
How long have you lived at this address? _________ Previous address, if less than 2 yrs.
________________________________________________ Years there_____________
What is the best way to contact you? Phone email When?_____________________
Pets
Have you ever owned a Yorkie? ______ If so, where is it now? ____________________
Do you have other pets? (If not, skip this section)______ List breed, age, and sex______
_______________________________________________________________________
Are all other pets current of all vaccinations? ______ Are they spayed/neutered? ______
If no to either, explain______________________________________________________
Are all pets on heartworm preventative? ______ Brand _________________________
Are all pets on flea control? _______ Brand __________________________________
Veterinarian’s name and phone______________________________________________
Approximate date of last Veterinarian visit for each pet___________________________
List all pets you’ve owned in last 10 years, not mentioned above, and their present status
General
Information
How did you hear about the Yorkie Friends Rescue? ____________________
Please, list any Breed, Humane Societies, Training Clubs, and similar organizations you support or belong to_______________________________________________________
Please, provide the name, address, and phone number of three professional references
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
In
What Areas Could You Work Within The Group?
_____ Foster (Complete
Required Foster Info Below.)
_____ Transport (Complete Required Transport
Info Below)
_____ Sewing _____ Fund Raising _____ Grant Writing
_____ Calling References (Do you have unlimited anytime long distance? ____ )
_____ Perform coordination duties such as management of membership data, foster dog
information, adoption application data, transport arrangements, etc.
_____ Web site and/or Petfinder listing management
Foster
and Care Information (Must Be
Complete Before Fostering A Dog)
Is everyone in your home agreeable to fostering a rescue dog? _______________
If not, who and why_______________________________________________________
Please circle the term(s) that best describes you current living situation:
House Condo Apartment Modular Home
Rent Own Living with Parents
If renting, Landlord’s name _____________________________Phone______________
If living with parents, Parents’ Names: ____________________ Phone______________
Social environment (circle one): Urban Suburban Country
Does your home have a backyard? ______ Is it fenced? ______ Fence type___________
Fence height______ Will gate be padlocked? ______ Is fence permanent? ____________
Is edge of fence buried to prevent tunneling? ______
Will dog be left alone during the day? ______ For how long? ______ Days per week____
Specifically what will be the dog’s living situation? (Examples-run of house, confined to one area, garage or basement)______________________________________________
Will the dog be crated? _______ If so, for how long? __________ How often? ________
Have you ever fostered any animal before? ______ Explain________________________
For what agency did you foster? _____________________ Phone__________________
Do you prefer: male or female? __________ Age range? _______ Size? ____________
Do you understand that often times the complete history of a rescue Yorkie may not be known? ______ Will you be willing to work with us to correct any possible behavior problems? ______
Social/Behavioral problems you could not handle:
Soiling floor Biting Dog/cat aggression Excessive barking Other ______________
Medical condition(s) you are not able to handle__________________________________
Are you willing to foster a dog until a permanent home can be found? ______
If not, maximum time frame you could keep a dog until other arrangements are made. __________________
Would you be willing to permanently foster a dog? ______________
Will you provide transportation of dog for veterinary care, adoption, etc.? _____
Veterinarian you will employ, name, address, and phone__________________________
________________________________________________________________________
Transport Information (Must Be Complete Before Transport.)
How far could you travel (one way) to transport a dog or dogs? ___________________
How many dogs could you transport at once? ______
When are you able to transport? Week-ends Only Days Evenings Any Time
If Specific Days, List: _____________
Do you have or would you be able to furnish crates for transport if necessary? _____
Do you have full coverage automobile insurance? ______ Liability? __________
Read the following carefully.
I declare that the information I have provided in this
application is complete and correct. I further declare that I am financially
and physically able to care for a rescue dog, specifically, a Yorkshire
terrier. I understand that proper food and veterinarian care may be costly, and
I am able and willing to meet the needs of the foster dog. I understand that
the Yorkie Friends Rescue will reimburse me for any
pre-approved medical expenses and impound fees related to the foster dog. I
understand that any food, toys, and travel expenses associated with the foster
dog are a donation and will not be reimbursed. {Yorkie
Friends Rescue is applying for status as a non-profit organization under
section 501 (c) (3)}.
I understand the requirements and grant permission for
Home Checks at random both prior to and during fostering. I submit that if a
Home Check reveals falsification or misrepresentation of any facts on my part,
the Yorkie Friends Rescue reserves the right to
either refuse fostering, to nullify any agreement between us and reclaim said
Yorkshire terrier from my premises, without reimbursement of the fostering
expenses.
I stipulate that I am a volunteer for the Yorkie Friends Rescue. I will provide automotive and health
insurance, and hold Yorkie Friends Rescue its
officers, members, volunteers, associates, or other foster care providers
harmless for any liabilities, whether damages are physical, emotional, or
property, that are a direct or indirect result of activities associated with
fostering, placement, transport, grooming, training, or evaluating of any
Yorkshire Terrier or other dog in any way associated with the Yorkie Friends Rescue, including any and all activities I
perform as a volunteer for the Yorkie Friends Rescue.
I have read the YFR, Inc “Code of Ethics” and
understand and agree with its contents and will abide by them. I further
understand that a Membership Coordinator will contact me regarding my
acceptance.
Applicant’s
signature__________________________________________ Date ______________________
Please mail this form to: Yorkie
Friends Rescue
c/o Jacki Mathis