Florida Dachshund Rescue – FLDR | Fostering Application

Name*

FirstLast

Address*

Street AddressAddress Line 2CityStateZip Code

Phone*

(xxx)xxx-xxxx format please

Alternate Phone

(xxx)xxx-xxxx format please

Main Email Address*

Alternate Email Address

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

Who will be primarily responsible for the care of the dachshund?

Is everyone in residence agreeable to fostering a dachshund?

Yes
No

Name & Ages of all people living 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 (Breed, Male/Female, Spayed or Neutered, Age)

Tell us about your current Pets

Are your pet (s) up-to-date on shots

Yes
No

On heartworm preventative

Yes
No

What type and brand of heartworm preventative do you use

Do you use flea preventative on your pets?

Yes
No

Please list type and brand

Would your pet (s) accept a new dog?

Yes
No

How will you introduce a foster to your pets

Have you had pets in the past?

Yes
No

Please tell us about them

Do you

What type of Dwelling is your home?

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.

Landlord's Name

FirstLast

Landlord's Address

Street AddressAddress Line 2CityStateZip Code

Landlord's Phone

FLDR has a total Restraint Policy:

Do you have a securely fenced yard?

Yes
No

What type of fence?

Fence Height

Are you willing to install a fence, pen or run

Yes
No

Leash walk at all times?

Yes
No

Do you have a doggie door?

Yes
No

Will the doggie door be open when you are not at home?

Yes
No

Will the dachshund be supervised when outside?

Yes
No

Where will it sleep at night?

Where will it be kept when left alone?

Where and how will the dachshund be exercised?

How many hours per day will the dachshund 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

Has been abused?

Yes
No

Is not reliable with children?

Yes
No

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.

Veterinarian's Name

FirstLast

Address

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Phone

How long have you been a client?

References

(Do not list any relatives or people living with you)

Name*

FirstLast

Reference 1

Address*

Street AddressAddress Line 2CityStateZip Code

Home Phone*

Email

Name

FirstLast

Address*

Street AddressAddress Line 2CityStateZip Code

Phone*

Email

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?

I understand that upon submitting this document for review, that it is legally binding and any false information given will be just cause for immediate denial of adopting a rescued dachshund from this organization.

Please type in your name below

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*

Typing your name into this box is your signature.

State that issued your Driver's License*

Drivers License Number*