If you are willing to foster a Yorkie, please fill out the form below with as much information as possible. The more information we have, the better we can determine if your are a good foster parent for a Yorkie.
PERSONAL INFORMATION
|
| Name |
|
| Age |
|
| Spouse |
|
| Age |
|
| Address |
|
| Apt/Suite/No. |
|
| City |
|
| State | Zip |
| |
| Email |
|
| Phone |
|
| Employer | Phone |
| |
| Spouse's Employer | Phone |
| |
| Number of Children |
|
| Ages (separate with comma) |
|
HOME INFORMATION
|
| How long have you lived at this address? |
|
| Years at previous address |
|
| Which best describes your current living situation? |
|
| If you rent, please enter your landlord's name |
|
|
& Phone:
|
|
| If less than two years, please list your previous address: |
|
| Social Environment (choose one): |
Urban | Suburban | Country |
| Besides your immediate family, are there others residing at your home? |
Yes | No |
| Other than immediate family, list all people living in your home and their ages |
|
| Does your family have a yard? |
Yes | No |
| Is it fenced? |
Yes | No |
| Fence type: |
|
| Fence height? |
|
| Will gate be padlocked? |
Yes | No |
| Is fence permanent? |
Yes | No |
| Is edge of fence buried to prevent tunneling? |
Yes | No |
FOSTER INFORMATION
|
| Why do you wish to foster? |
|
| Is everyone in your home agreeable to fostering a Yorkshire Terrier? |
Yes | No |
| If not, who and why? |
|
| Will the dog be left alone during the day? |
Yes | No |
| For how long? |
|
| If not, where will the dog stay while you are gone? |
|
|
We will only place our Yorkies in inside living conditions. Specifically, what will be the dog’s living situation? |
|
| If other, please explain: |
|
| Have you ever owned a Yorkie? |
Yes | No |
| Where is that Yorkie now? |
|
| Have you ever fostered an animal in the past? |
Yes | No |
| Explain: |
|
| Through which agency? (name | phone ) |
| |
| Do you prefer a male or female Yorkie? |
Male | Female |
| Age Range? |
|
| Other criteria for dog you'd be willing to foster: |
|
| Are you willing to foster dogs with healthcare issues? |
Yes | No |
| Are there medical conditions or behavior issues you are not able to handle: |
|
| Are you willing to foster senior dogs? |
Yes | No |
| More than one? |
Yes | No How many? |
| For what period of time are you willing or able to foster? |
Until permanent home can be found |
| Until other arrangements can be made. |
| Only for short periods of time. |
| For extended periods. |
| If you chose for short periods or extended periods, what is your maximum time frame? |
|
Are you willing to provide transportation to and from the vet, adoption sites, etc. as needed?
|
Yes | No |
| Veterinarian you will use for foster Yorkies in your care? |
Name: |
| Address: |
| Phone: |
OTHER PET INFORMATION
(Skip this section if N/A)
|
| Do you have other pets? |
Yes | No |
| List breed, age, sex: |
|
| Are all other pets current on all vaccinations? |
Yes | No |
| Are they spayed/neutered? |
Yes | No |
| If no to either, explain: |
|
| Are other pets on heartworm preventative? |
Yes | No |
| Brand? |
|
| Are other pets on flea preventative medications? |
Yes | No |
| Veterinarian's Name |
|
| Veterinarian's Address |
|
| Veterinarian's Phone |
|
| Veterinarian records under what pet names: |
|
| Owner name registered with veterinarian: |
|
| Approximate date of last veterinarian visit for each pet: |
|
| List the pets have you owned in the past ten years and what happened to them: |
|
GENERAL INFORMATION
|
| How did you hear about Yorkshire Terrier Rescue Network? |
|
| Please, list any Breed, Humane Societies, Training Clubs, and similar organizations you support or to which you belong: |
|
| We will provide you with as complete as possible evaluation of the temperament of any foster Yorkie placed in your care. Do you understand that often the complete history or behaviors of a rescue Yorkie may not be known? |
Yes | No |
| Will you be willing to work with us to correct any possible behavior problems? |
Yes | No |
| Please, provide the name, address, and phone number of three references. One reference should be a vet you have used in the past. Please include name of animals who were patients with this vet. |
|
|
| Please enter any additional comments/questions: |
|
|
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 foster Yorkshire Terrier. I understand that proper food and veterinarian care may be costly. I am able and willing to meet the needs of the foster dog during the time the dog is in my care. I understand that the Yorkshire Terrier Rescue Network, 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. 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 Yorkshire Terrier Rescue Network, Inc. reserves the right to refuse fostering and to nullify any agreement between us. YTRN, Inc. may also claim said Yorkshire Terrier from my premises without reimbursement for fostering expenses.
I stipulate that I am a volunteer for the Yorkshire Terrier Rescue Network, Inc. I agree to provide personal automotive and health insurance. I will hold Yorkshire Terrier Rescue Network, Inc., its officers, members, volunteers, associates, or other foster care providers harmless for any damages (physical, emotional, or property) that are a direct or indirect result of any activities associated with placement, transport, grooming, training, or evaluation of a dog associated with the Yorkshire Terrier Rescue Network, Inc.
I have read the YTRN, Inc “Code of Ethics” and Operating Guidelines. I understand all contents and agree to abide by the terms of these documents. I further understand that a Volunteer Coordinator will contact me regarding my acceptance as a foster.
Please submit via online form and mail a signed hard copy to:
Yorkshire Terrier Rescue Network, Inc.
c/o Janine Huber
415 Augusta Drive
Statesville, NC 28625
|
|
