NC Yorkie Rescue: Foster Application

First & Last Name (Applicant) *

age? *

Email *

Phone (111-111-1111) *

Occupation & Place of Business *

First & Last Name (Co-Applicant)

Are y What is your age?

Email

Phone (111-111-1111)

Occupation & Place of Business

Please list names & ages of all persons living in your home *

Is anyone living in this home a smoker? *

Yes

No

Your Home

Street Address (Home) *

City *

ST *

ZIP *

Do you own or rent? *

Own

Rent

Do you live in a: *

House

Townhouse/Condo

Apartment

Do you have a fenced yard? *

Yes

No

Type of Fence

Wood	Chain-Link
Iron	Other

Fence height (ft)?

Is fence secured to home?

Yes

No

Is fence base buried (to prevent tunneling)?

Yes

No

Pet Owner History

Name of Vet *

Name of Vet Office *

Vet Phone (111-111-1111) *

List any current (and recent) pets in your home. Please indicate the breed, age and health status of each. *

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Foster Dog Environment

Have you ever fostered an animal before? *

Yes

No

If yes, please provide the name and phone of prior agency.

If yes, please explain.

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Have you ever owned a Yorkie? *

Yes

No

If yes, where is it now?

Is everyone in your home agreeable to fostering a Yorkie? *

Yes

No

How many hours per day will the foster dog be alone? *

Where will the foster dog stay when alone in your home? *

In a crate

In a gated area (e.g. kitchen or bathroom)

In the garage or outside

Will have free run of the house

Other (please explain) Other (please explain)

Where will the foster dog sleep at night while staying in your home? *

If you must leave town (e.g. vacation, business, emergency) what will you do with the foster dog? *

Hire a pet sitter to stay in my home at night and visit during the day

Hire a pet sitter to visit during the day (dog will be alone at night)

Have a neighbor check on the dog

Take dog to a boarding facility

Take dog with me

Call NC Yorkie Rescue to make arrangements for the dog's care

Other (Please explain) Other (Please explain)

How far are you willing to drive to pick up a foster dog? *

Are you willing to foster a dog until a home can be found? If not, what is the maximum time frame you can foster a dog? *

Please describe the dog's living situation: where will the dog sleep? how will the dog exercise? will the dog have run of the house, basement, yard? how many hours will the dog be alone during a normal day? *

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I prefer to foster a: *

Male

Female

Either

I prefer to foster a: *

Puppy (0-2 years)

Young dog (2-7 years)

Senior (7-12 years)

Would you foster a special needs dog? *

Yes

No

Would you provide respite care to a terminal dog? *

Yes

No

If yes, are there any medical conditions you would NOT be able to handle? *

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NC Yorkie Rescue Inc. will provide all available information on the temperament and health of your foster Yorkie. In some cases, the dog's complete health history is not known. Do you accept this and agree to work with us? *

Yes

No

Personal References

Name *

Relationship *

Phone (111-111-1111) *

Name *

Relationship *

Phone (111-111-1111) *

Name *

Relationship *

Phone (111-111-1111) *

Fostering Terms of Agreement

I understand and agree that:

1. The dog is the legal property of NC Yorkie Rescue Inc.

2. I am offering my home as a temporary shelter for a dog in the care of NC Yorkie Rescue Inc.

3. If I do not wish to continue to foster the dog that is placed with me, I must contact a NCYR Board member immediately to arrange the return of the foster dog to a NC Yorkie Rescue Inc representative.

4. Food, toys and travel expenses associated with a foster dog will not be reimbursed and are considered a donation to NC Yorkie Rescue Inc., a non-profit organization under section 501 (c) (3).

5. NC Yorkie Rescue Inc is responsible for finding the foster dog a permanent home. However, I will make the dog available to visit with an approved adopter at a mutually convenient time.

6. If the foster dog needs to be medically examined or treated, the visit/expense must be approved in advance by a NCYR Board member and will normally occur at one of our rescue-friendly vets.

7. Random Home Checks may occur both prior to and during fostering. If a Home Check reveals falsification or misrepresentation of any facts on my part, I acknowledge that 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.

8. My failure to follow the foster policies and procedures of NC Yorkie Rescue Inc. will cause me to relinquish the dog and will prohibit me from fostering a dog with NC Yorkie Rescue Inc. in the future.

I declare that

1. I am physically and financially able to properly feed and care for a rescue dog; specifically, a Yorkshire Terrier.

2. While I am a volunteer with NCYR Inc, I will not belong to or volunteer for any other Yorkshire Terrier "Yorkie" Rescue group, as it is a conflict of interest to do so.

3. 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 NC Yorkie Rescue, Inc., including any and all activities I perform as a volunteer for NC Yorkie Rescue, Inc.

4. The information I have provided in this application is complete and correct.

5. 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.

Name & Date (Signature & ID will be required when you pick up your foster dog.) *