Foster Application If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required First Name * Last Name * Date of Birth * Address 1 * Address 2 City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampsire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code * Email * Phone * Please describe your living arrangements. Do you live in a house, apartment, townhome, condo, duplex, or other? * Do you own or rent your home? * If you rent, please provide your landlord's contact information. Please list the name, age, and relationship of those persons residing with you. * Do you currently own pet/s or are there pets living in your home? * If yes, please list their species, age, breed, sex, whether they are spayed or neutered, up-to-date on vaccines (including if you use heartworm preventative), and each pet's personality characteristics/temperament. * Please provide your veterinarian's name and contact information. * May we contact your veterinarian? * Yes No How many hours will your foster dog be left alone during the day? * Where will your foster dog stay when left alone? * Where will your foster dog sleep at night? * Do you have a yard? If so, is it fenced, what kind of fence, and what is the height? * If you don’t have a yard, how will you accommodate your foster dog's needs? * Please describe the physical activity level of your home. * What kind of exercise and activities will you provide a foster dog? * Do you have nieces, nephews, grandchildren, neighborhood kids, etc. who visit often? Please explain. * Please describe your experience in training, rehabilitation, and any other activities involving dogs. How much and/or what kinds of training are you willing to do with your foster dog, i.e. crate-training, house-training, basic commands, behavioral training? * What age dogs are you interested in fostering? * Bottle feeder puppies Puppies 8-months-old or younger Young adults ( 8-months-old to 2-years-old) Adults (2+ years-old) What size dog would you prefer to foster? * Are you able to foster males and/or females? * Males Females Either Would you accept a dog who has special needs? * Yes No Would you accept a foster dog who requires medical care? * Yes No Would you be willing and able to provide the care? * Yes No Would you accept a dog that has been abused or neglected? * Yes No Would you accept a dog that is not reliable with children? * Yes No Would you accept a dog that is pregnant and will be whelping? * Yes No Is there anything you feel CCR should know about you or your abilities to provide a foster home? The Foster Parent hereby declares that he/she is aware: a) That animals are different from human beings in their responses to human actions; b) That the actions of animals may be unpredictable; c) That an animal’s behavior may change after it leaves the shelter and accustoms itself to a home or other different environment; d) That the Colorado Canine Rescue makes no claims as to the temperament, health, or mental disposition of any animal put up for adoption The Foster parent acknowledges that he/she has received a copy of the Colorado Canine Rescue Animal Foster Home Policy and understands and agrees to all policies. GENERAL RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISKS, AND HOLD HARMLESS AGREEMENT You, the foster family of the dog, and your estate, heirs, administrators, executors, and assigns, hereby release, forever discharge and hold harmless Colorado Canine Rescue, to include but not limited to owners, their heirs, employees, representatives, agents and volunteers (collectively called, the “RELEASEES”) from any and all liability and responsibility whatsoever, however caused, for any and all damages, claims, demands, or causes of action that you, your estate, heirs, administrators, executors, or assigns may have for any loss, illness, personal injury, death, or property damage arising out of, connected with, or in any manner pertaining to the RELEASEES’ presence in, on, or upon the property whether caused by negligence of the RELEASEES, accident, deliberate act, omissions, or otherwise. You, the foster family, understand and acknowledge the fact that canines can be unpredictable and CCR is not responsible if injury should occur to you, any members of your family, or third parties resulting from the canines fostered or adopted through the CCR program. In signing this agreement, you, the foster family of the dog, acknowledge and represent that you have read and understand this agreement; that you sign this agreement voluntarily; no oral representations, statements, or inducements have been made; you are at least eighteen years of age and fully competent; you understand that you are giving up substantial rights by signing this agreement; and you voluntarily agree to be bound by this agreement. I am I full agreement with the CCR foster program and foster care responsibilities. By signing below I am attesting to the truthfulness of my answers. Signature * Date *
