FLDR Volunteer Foster Application

Please provide the following contact information:

Date Submitted:

*Name: 

*Address: 

*City:    *State: FL GA LA AL    *Zip: 

*Main e-mail address:

Alternate e-mail address:

*Home Phone: 

Cell Phone:

Employer:

Your position:

How long have you been employed at present company?

Work Telephone:

Spouse's Employer:

Spouse's Position:

How long has spouse been employed at present company?

Spouse Work Telephone:

What are the working hours of the adults in the house?:

How many people live in your household?:

Names and ages of all people that live in your home:

Please describe the activity level of the house - busy in and out a lot or is it a more quiet, structured atmosphere?:

Please list pets you now have in your home. Be sure to include the following information on each of your current pets (if you need more room, please list them in the box below labeled "Tell us about your current Pets):

Tell us about your current Pets:

Is your pet up-to-date on its shots?: yes no   Heartworm preventative?: yes no

What type and brand of heartworm preventative do you use?: 

Do you use flea preventative on your pets?: yes no

If yes, please list type and brand:

Would your pets accept a new dog?: yes no

How will you introduce a foster to your pets?

Have you had pets in the past? yes no (this would be any pets other than current)

If so, please tell us about them:

Do you?: Own Rent   A House Apartment Condo Mobile Home Other If Other, please specify:

How long at current address?

If less than 5 years at current address, please list prior address:

PLEASE NOTE: We require the landlord's written consent for you to have a dog. If you are renting, you must include the Landlord's information below. Without this information, your application will not be processed.

DRF Inc., has a total Restraint Policy:

Do you have a securely fenced yard? yes no

What type of fence:    How high?:

If not, are you willing to fence, install a pen or run, or at least leash walk the dog at all times?: yes no

Please specify:

Do you have a doggie door?: yes no

Will the doggie door be open when you are not at home? yes no

Will the dog be supervised when outside?:  yes no

Where will the dog be kept during the day?:

Where will the dog sleep at night?:

Where will it be kept when left alone?:

Where and how will the dog be exercised?

How many hours per day (realistically) will the dog be left alone?

Dachshunds vary greatly in temperament, personality, and activity level:

What characteristics would you find undesirable in a foster dachshund?:

Would you accept a dog:

• That is older? yes no
• That has been abused? yes no
• That is not reliable with children? yes no
• That has a physical handicap?: yes no
• That is pregnant and are you willing to do whelping?: yes no
• That is recovering from medical treatment and may need foster care for 2 to 4 months or longer?: yes no

Please describe any experience you may have had in training and/or rehabilitation work with animals.

If necessary, would you be willing to take a foster dog to obedience training (at FLDR's expense) or to obedience train him/her yourself?: yes no

Would you be willing to participate in transport of the dachshund in your care or any dachshund that is in need of transport?: yes  no 

Would you feel comfortable doing home/reference checks on prospective adoptive families in your area following our guidelines? yes  no 

Do you feel you could help make the decisions about what home is right for the foster dog? yes  no 

Could you care for a dachshund recuperating from surgery or heartworm treatment until he/she is strong enough to be placed in a new home? yes  no 

Please list any experience you have with canine diseases or medical issues such as heartworms, ruptured discs, back surgery, Cushings Disease, whelping puppies, blindness, epilepsy, diabetes, mange, etc.:

Your Veterinarian:

*Name: 

*Address:

*City/State/Zip:

*Phone:

*How long have you been a client?

PERSONAL REFERENCES: Only one reference may be an immediate family member.

Reference #1:

*Name:

*Address:

*City/State/Zip:

*Phone:

E-mail address:

*How long have they known you?

Reference #2:

*Name:

*Address:

*City/State/Zip:

*Phone:

E-mail address:

*How long have they known you?

Reference #3:

*Name:

*Address:

*City/State/Zip:

*Phone:

E-mail address:

*How long have they known you?

Are you now working with a shelter or another rescue organization? yes  no 

If yes, what is the name of the organization and your position or duties?

Have you in the past worked with a shelter or another rescue organization? yes  no 

If yes, what was the name of the organization and your position or duties?

SIGNATURE SECTION:

I understand that FLDR, Inc., will be responsible for any medical, training, or other approved expenses associated with the foster dog in my care.

I understand that by signing this form, I agree to release and covenant to hold harmless FLDR, Inc., and its members from any claims, damages, costs, or actions incurred as a result of the foster care or actions of the foster dog.

I will notify FLDR immediately should the foster dog become seriously ill, lost, stolen, or die. The foster dog will wear an ID tag at all times. 

I understand that should I decide to permanently adopt the FLDR foster dog in my care, I will pay FLDR the adoption fee to help defray the costs of spaying, neutering, shots, heartworm test and other medical expenses that have been incurred by FLDR.

I certify that I am at least 25 years of age and that I will be solely responsible for the care and well being of any Dachshund Rescue of Florida (FLDR) foster dog that is in my care.

Any misrepresentation of the true facts in this volunteer application will invalidate the foster home agreement and will give FLDR the right to immediately reclaim the foster dog.

*Signature: _______________________________________________________
                

*State that issued your Driver's License:

*Driver's License Number: