Application Form

Foster Parent Application

Please note, the Foster Waiver and Liability Release found at the bottom of this form MUST be completed before an application will be approved.

Contact Info

First Name Last Name Street Address City State Zip Cell Phone Home Phone Email

Occupation(s) Hours Worked Per Week List names and ages of all household members List any current pets you have (name, breed, age, spayed/neutered, time owned) Are all the other animals in your home or care, fully vetted and up-to-date on all vaccinations? If no, why?

Veternarian's Name

First Last Address City State Zip Code

Phone Email

What type of area do you live in?

Rual

Suburban

Urban

Size and description of your yard Describe your home (sq ft., 2 story, apartment) Describe your fencing, including height, type, and portion of yard fenced

If you rent, do you have written permission from your landlord:

Yes

Name and phone number of landlord: Do you have any experience with the Border Collie breed? Please describe

About the dog you want to foster

Are you interested in a particular dog? If so, which one? What traits do you consider undesirable? Does your foster dog need to be good with children under 12? If yes, what are the ages of the children that the dog will regularly come in contact with? What activity level do you desire in your foster dog?( Couch potato, active companion, performance dog, working dog, family pet, etc) Are you willing to work on basic obedience and socialization with your foster dog? Describe an average day for you and your foster dog Describe the dog's living quarters, where will they sleep, eat, spend time during the day and at night, left when no one is home, playtime, mental stimulation and exercise opportunities, etc. and a general routine for you and your dog

What age of dog do you prefer to foster ?(Check all that apply):

< 6 mos

7mos - 2yrs

> 5 yrs

Senior

Do you have a gender preference?

Male

Female

No Preference

Have you previously fostered for another shelter or rescue group?

Yes

If Yes, name, address and phone number of that shelter or group

General Dog Responsibility and Care

Dog/Applicant Compatibility

If you are interested in a specific dog, the Foster Director will discuss as much about the dog as possible to determine if the dog is an appropriate fit for your home. The Foster Director and board members of Clancy's Dream retain the right to confirm, redirect or deny any application for fostering and/or adopting.

What will you do if the dog displays unwanted behavior such as barking, digging, chewing, etc? Do you have any questions or concerns about fostering?

Signatures of all members of the home over the age of 18

Signature Date Signature Date Signature Date Signature Date

FOSTER WAIVER AND LIABILITY RELEASE

Foster Parent Name

First Last

Co-Foster Parent Name

First Last Address City State Zip Code

Phone Phone Email Email

EMERGENCY CONTACT INFORMATION

In Case of emergency, I authorize Clancy's Dream Border Collie Rescue, Inc., to notify the contacts listed below.

Primary Contact Name

First Last Primary Contact Address City State Zip Code

Primary Contact Phone Primary Contact Alternate Phone

Secondary Contact Name

First Last

Secondary Contact Address

Address City State Zip Code

Phone Phone Email Email

I understand that because I may handle and/or come in contact with animals, it is important to discuss being vaccinated against tetanus with my physician. I release Clancy's Dream Border Collie Rescue, Inc., from all responsibility that may occur because of my not pursuing this matter further and I understand whatever decision I make regarding vaccination, I make at my own risk. I have read, understand and agree to the above tetanus information

Foster Parent Initial Co-Foster Parent Initial

I acknowledge and understand that as a foster parent for Clancy's Dream Border Collie Rescue, Inc., I am not covered by worker's compensation or any other insurance policy through Clancy's Dream Border Collie Rescue, Inc., for any damages or injuries I may sustain during my work as a foster parent for Clancy's Dream Border Collie Rescue, Inc.

Foster Parent Initial Co-Foster Parent Initial

I fully understand that as a part of my foster work for Clancy's Dream Border Collie Rescue, Inc, I will come in contact with animals either by directly handling them, fostering, or through assisting in their care and adoption. Further, I understand that working with animals carries a risk of injury and that it is possible that I may be bitten, scratched and/or otherwise injured.

Foster Parent Initial Co-Foster Parent Initial

I fully understand that as a foster parent for Clancy's Dream Border Collie Rescue, Inc., my family and/or guests may come in contact with animals in my home. I understand that working with animals carries a risk of injury and it is possible that my family and/or guests may be bitten, scratched and/or otherwise injured.

Foster Parent Initial Co-Foster Parent Initial

I hold a valid Driver's License

Yes

State of issue:

Co-Foster holds a valid Driver's License

Yes

Co-Foster Driver's License state of issue

I have valid automobile insurance

Yes

Name of insurance company

Co-Foster holds valid automobile insurance

yes

Co-Foster name of insurance company

Must read our Transportation Guidelines. Transportation Guidelines.

I have read and understand Clancy's Dream Transportation Guildelines

Yes

My signature to this foster liability release attests to my intent to hold harmless and release from all liability, Clancy's Dream Border Collie Rescue, Inc., or any of it's past, present or future officers, agents, volunteers, employees or assigns, from all acts which are related to the normal performance of required and implied duties. My signature, whether original, faxed, or any other electronic means, is valid as if it were an original signature. Foster Parent Signature Date Foster Parent Signature Date Clancy's Dream Representative Signature Date