Online Application to Foster

Applicant 1: First Name

Last Name

Applicant 2: First Name

Last Name

Applicant 1: Occupation

Applicant 2: Occupation

Email Applicant 1

Email Applicant 2

Address

City

State

Applicant 1: Hm Phone

Cell Phone

Work Phone

Applicant 2: Hm Phone

Cell Phone

Work Phone

Home Info

Do you live in a house or apartment?

House

Apartment

Do you own or rent?

Own

Rent

If you rent, do you have your landlord's permission to foster a dog?

Yes

No

N/A

What is your landlords name and phone number?

Social environment

City

Suburbs

Country

Fence/Backyard Info

Does your home have a backyard?

Yes

No

Is the backyard fenced?

Yes

No

If Yes, is it attached to your home?

Yes

No

Is the fence permanent?

Yes

No

Is it secure?

Yes

No

What type of fence is it?

Is the edge of the fence buried to prevent tunneling?

Yes

No

Foster and Care Information

Have you ever fostered an animal before?

Yes

No

If Yes, explain.

If Yes, what agency did you foster for?

Agency Phone #

Have you ever owned a Yorkie?

Yes

No

If Yes, where is it now?

Are you willing to foster a dog until a permanent home can be found?

Yes

No

If No, what is the maximum time frame you can foster a dog?

Is everyone in your home agreeable to fostering a Yorkshire Terrier?

Yes

No

If No, who and why do they not agree to foster?

List all persons living in the home and their ages.

What is the average length of time during the day the dog will be left alone?

Specify the dogs living situation (i.e. run of the house, basement, outside, etc.)

If outside, describe the kennel, dog house or other facility where the dog will be kept.

Gender preference?

Male

Female

Either

Age Range

Would you take a special needs dog?

Yes

No

What medical conditions would you not be able to handle?

Name of veterinarian you plan to employ.

Phone #

We will provide you with all available information about the temperament of your foster Yorkie.

Do you understand that often times the complete history of a rescue Yorkie may not be known?

Yes

No

Will you be willing to work with us to correct any behavior problems?

Yes

No

Other Pet Experiences

Do you have other pets?

Yes

No

N/A

# of dogs?

# of cats?

Other pets?

Are they all current on all vaccines and heartworm preventions?

Yes

No

N/A

Are all your cats or dogs spayed or neutered?

Yes

No

N/A

Name of current veterinarian.

Phone #

List all pets you've owned in the last 10 years and their current status.

References

Name

Phone #

Name

Phone #

Name

Phone #

General Info

How did you hear about NC Yorkie Rescue, Inc.?

List any Breed, Humane Society, Training Clubs and similar organizations you belong to or support.

Fostering Terms of Agreement

I am aware and understand that I am offering my home as a temporary shelter for NC Yorkie Rescue, Inc. During this time I am aware everything possible will be done to find the foster Yorkie(s) a permanent home. I am aware and agree to make the foster Yorkie(s) available to be viewed by perspective owners at the convenience of the Foster family. If I decline to follow the policies and procedures for foster care I will be required to relinquish the Yorkie(s) and will no longer be allowed to foster a dog with NC Yorkie Rescue, Inc.

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 NC Yorkie Rescue, Inc. 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. NC Yorkie Rescue, Inc. is a non-profit organization under section 501 (c) (3).

I understand the requirement 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 NC Yorkie Rescue, Inc. 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 NC Yorkie Rescue, Inc. I will provide automotive and health insurance, and hold NC Yorkie Rescue, Inc. 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 placement, transport, grooming, training, or evaluating of any Yorkshire Terrier or other dog in any way associated with the NC Yorkie Rescue, Inc., including any and all activities I perform as a volunteer for the NC Yorkie Rescue, Inc..

I have read the NC YORKIE RESCUE, Inc “Code of Ethics” and understand and agree with its contents and will abide by them. I further understand that a Volunteer Coordinator will contact me regarding my acceptance.

Printed Name

Date

Your signature will be required below when you pick up your dog.

Name

Date

Indicates Response Required