Foster Application

SECTION 1 - Personal Information

Your Name*

Age*

Address (including City, State & Zip code)*

Primary Phone*

Your Email*

Please list the names, ages, and relationship of other people living in home.

SECTION 2 - Employer Information

Employer Name*

Employer Address (including City, State & Zip code)

Employer Phone*

SECTION 3 - Residence Information

Ownership*
LeaseRentOwnLive with Friend(s)Live with Parent(s)

Type*
HouseCondo/TownhouseApartmentMilitary HousingOther

Location*
CitySuburbanRural/Country

If you selected "Other", please describe

If you Rent or Lease, please provide the contact information of your landlord of property owner who holds your lease/rental agreement.(Address, City, State, Zip Code, & Phone Number)

How long have you lived at your current address?*

If less than 2 years, please list previous address for the last two years.

Does your home have a yard?*
YesNo

Does your yard have a fence?*
YesNo

What type of fence?

Height of Fence? (in feet)

How will gates be secured?

Do you have a swimming pool or spa?*
YesNo

SECTION 4 - Day to Day Living
Is someone home during the day?*
YesNo

If no, where will the dog stay while you are gone?

Where will your dog be kept most of the time?*
InsideBasementOutsideGarageOther"]

If kept outside, will you have a dog run and/or dog house? Please specify.

Would you let the dog outside by itself?*
YesNo

Check any of the following you feel are valid reasons for giving away a pet:
FleasHaving a babyGetting married/divorcedSheds too muchToo expensiveRelocating to another State/CountryFound a new place to live but they don't allow petsChew or destroys household objectsChild(ren) no longer take care of itOther

If Other, please specify.

Have you every had to surrender a dog or other pet?*
YesNo

If Yes, please describe

If you have owned other dogs and do not now, what happened to them?

SECTION 5: Other Pet Information
Do you have any other pets?*
YesNo

If Yes, please fill out the following:

Name

Type (cat, dog, etc)

Age

Current on Vaccinations?
YesNo

Name

Type (cat, dog, etc)

Age

Current on Vaccinations?
YesNo

Name

Type (cat, dog, etc)

Age

Current on Vaccinations?
YesNo

Are your animals on heartworm prevention?
YesNo

Type/Brand

Veterinarian Contact information (Name, Clinic, Address, City, State, Zip Code, & Phone Number)

If applicable, approximate date of your current pet’s last office visit

Are all of your dogs spayed or neutered?
YesNo

If not, please explain why:

SECTION 6: You & Your Foster Dog

Training with your foster dog
Which of the following methods/tools do you/would you use in training a dog?*
Choke ChainFood RewardToy RewardClicker/Operant ConditioningHarnessGentle Leader or other Head CollarElectric/Stimulation Training Collar (E-collar)Prong/Pinch CollarOther

If Other is selected, please explain.

SECTION 7: Additional Comments
Additional Comments

SECTION 8: References
Please note that we will be unable to process your application without THREE references.
ONLY ONE FAMILY MEMBER MAY BE LISTED AS A REFERENCE

Reference 1*
Name

Address City, State ZIP

Phone Number

Email

Years Known

Relationship

Reference 2*
Name

Address City, State ZIP

Phone Number

Email

Years Known

Relationship

Reference 3*
Name

Address City, State ZIP

Phone Number

Email

Years Known

Relationship

How did you hear about Nebraska Border Collie Rescue, Inc.?*

SECTION 9: Terms & Conditions
Do you understand that a home visit is REQUIRED before you will be approved to foster?*
YesNo

I certify that the information provided on this form is true and correct, to the best of my knowledge. I am also financially and physically able to care for this animal. I understand that proper food and veterinary care can be costly and I am able and willing to meet these requirements. Home checks are made on a random basis following or prior to adoption. If upon inspection we find that the information contained in this application to be false, we retain the right to deny your application and/or remove the animal from your premises without a refund of monies paid.

By checking this box and/or signing this form you acknowledge the above statement and agree to accept all terms and conditions herein. A signed application form must be received before your application can be considered.
I Agree

AUTHORIZATION TO RELEASE PERSONAL INFORMATION

Part of the adoption process for NBCR, Inc. is to contact your vet listed as a reference in your application. Due to recent concerns for personal information being given out, many vet clinics will not release personal information for our prospective adopters. In order for NBCR, Inc. to fully complete your application. PLEASE check with your vet clinic for their procedures for RELEASE of PERSONAL INFORMATION or fill the form out below and give to your vet clinic as soon as possible for your application to be completed.

This form has been devised to protect your rights to privacy. Please note that the form specifies with whom information about you may be exchanged and the purpose, nature or extent of the information. Please be sure all information is filled in before you sign.

I authorize: (Name of Vet Clinic or Doctor)

To exchange information with: Nebraska Border Collie Rescue, Inc.(NBCR) / or a representative from NBCR, Inc.

Purpose and extent of information:
To review the possible adopters current or past pet(s) history of care for possible adoption of pet(s) from Nebraska Border Collie Rescue, Inc.

Valid from date signed* (today's date)

Type your Name here to sign*

Note: * denotes a required field