Yorkie Friends Rescue

Yorkie Friends Rescue

Application for Membership & Fostering

Personal Information:

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 ages:

.

How long have you lived at this address?

Previous address if less than 2 years:

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

There 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:

1.

2.

3.

In What Areas Could You Work Within The Group?

Foster (Complete Required Foster Information Below.)

Transport (Complete Required Transport Information Below.)

Sewing

Fund Raising

Grant Writing

Calling References (Do you have unlimited 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 your current living situation:

HouseCondoApartment Modular Home

RentOwnLiving with parents

If renting, Landlord’s name:Phone:

If living with parents, Parent’s names:Phone:

Social environment (circle one): UrbanSuburban 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 the 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:Phone:

Address:

City:State:Zip

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 expense and impound fees related to the foster dog. I understand that any food, treats, flea prevention, and possibly heartworm prevention, toys, beds, collars and leashes, grooming, and travel expenses associated with the foster dog are a donation and will not be reimbursed. {Yorkie Friends Rescue is a non-profit organization under section 501c-3, and donations are tax deductible.}.

I understand the requirements and grant permission for Home Check at random both prior to and during fostering. I submit that if a Home Check reveal 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 agree to allow YFRC to use any pictures of me, my family, and/or my dogs on the YFRC website if I submit them to be placed there. They may be used in the Successful Adoptions pages, the Yorkie Friends Families pages, or other areas of the website. They may remain there after my membership with YFRC ends.

I stipulate that I am a volunteer for the Yorkie Friends Rescue. I will provide automotive and health insurance, and homeowners insurance, and hold Yorkie Friends Rescue and its officers, members, volunteers, associates, and 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 understand that Yorkie Friends Rescue Corporation is unable to provide liability insurance, and that any claims for damages could be filed against my homeowners or car insurance.

I agree to read the YFR By-laws, Organizational Procedures, and Code of Ethics and will abide by them. I further understand that a Membership Coordinator will contact me regarding my acceptance.My signature confirms that I have read and agree with all requirements set forth on this form.

Applicant’s signature:Date:

Please mail this form to:

Yorkie Friends Rescue Corporation

Beverly Harvey

968 Morgan Street

Moulton, AL35650