Yorkie Friends Rescue
                          Application for Membership & Fostering

Personal Information:

Name:                                                                               Age:                                              

Spouse’s Name:                                                                Age                                               

Address:                                                                                                                                 

City:                                                State:                        Zip:                                                 

E-Mail Address:                                                                                                                      

Home Phone:                                        Cell Phone:                                                                

Employer:                                                                Phone:                                                     

Spouse’s Employer:                                                        Phone:                                              

Number of children living at home:                                        Ages:                                         

Other than immediate family, list all living in your home and ages:                                          

._______________________________________________________________________


How long have you lived at this address?_______________________________________

Previous address if less than 2 years:                                                                                   

Years there?                                                                                                                          

What is the best way to contact you?           Phone:                Email:                When?          

PETS:

Have you ever owned a Yorkie:                 If so, where is it now?                                            

Do you have other pets? (If not, skip this section)                                                                 

List breed, age and sex :                                                                                                      

Are all other pets current of all vaccinations ?                                                                     

Are they spayed/neutered ?                                                                                                 

If no to either, explain:                                                                                                          

Are all pets on heartworm preventative?                           Brand:                                         

Are all pets on flea control?                                          __Brand:____________________

Veterinarian’s name and phone#:                                                                                        

Approximate date of last Veterinarian visit for each pet:                                                       

List all pets you’ve owned in last 10 years, not mentioned above and
their present status:                                                                                                                 

_______________________________________________________________________

General Information:

How did you hear about the Yorkie Friends Rescue?                                                          

Please, list any Breed, Humane Societies, Training Clubs, and similar organizations you
support or belong to:____________________________________________________

Please provide the name, address, and phone number of three professional references:

1.                                                                                                                                          

2.                                                                                                                                         

3.                                                                                                                                             


In What Areas Could You Work Within The   
Group?
                                                               
          Foster (Complete Required Foster Information Below.)                                           
          Transport (Complete Required Transport Information Below.)                                
          Sewing                                                                                                                     
         Fund Raising                                                                                                            
          Grant Writing                                                                                                           
          Calling References (Do you have unlimited long distance?)                                    
          Perform coordination duties such as management of membership data, foster        
          dog information, adoption application data, transport arrangements, etc.               
          Web site and/or Petfinder listing management                                                         



Foster and Care Information (Must be complete Before Fostering A Dog)

Is everyone in your home agreeable to fostering a rescue dog?                                           

If not, who and why:                                                                                                                

Please circle the term(s) that best describes your current living situation:

House                Condo                Apartment                     Modular Home                               

Rent                Own                Living with parents                                                                    

If renting, Landlord’s name:                                                Phone:                                         

If living with parents, Parent’s names:                                        Phone:                                  

Social environment (circle one):          Urban                Suburban                  Country             

Does your home have a backyard?              Is it fenced?                  Fence Type:                  

Fence height:                    Will gate be padlocked?           Is Fence Permanent?                    

Is edge of fence buried to prevent tunneling?                                                                         

Will the dog be left alone during the day?        For how long?                  Days per week?      

Specifically what will be the dog’s living situation? (examples – run of house, confined to
one area, garage or basement):                                                                                              

Will the dog be crated?               If so, for how long?                    How often?                         

Have you ever fostered any animal before?                                                                            

Explain:                                                                                                                                   

For what agency did you foster?                                                  Phone:                                

Do you prefer: Male or Female?                    Age range?                        Size?                       

Do you understand that often times the complete history of a rescue Yorkie may not be
known?                                                                                                                                    

Will you be willing to work with us to correct any possible behavior Problems?                       

Social/Behavioral problems you could not handle:
  Soiling floor                                                                                                                      
  Biting                                                                                                                                
  Dog/Cat aggression                                                                                                         
  Excessive barking                                                                                                            
  Other: Specify:                                                                                                                 

Medical condition(s) you are not able to handle:                                                                     

Are you willing to foster a dog until a permanent home can be found?                                   

If not, maximum time frame you could keep a dog until other arrangements are made?          

Would you be willing to permanently foster a dog?                                                                  

Will you provide transportation of dog for veterinary care, adoption, etc?                              

Veterinarian you will employ:
Name:                                                                        Phone:                                                  

Address:                                                                                                                                 

City:                                        State:                                Zip                                                  

Transport Information (Must be complete Before Transport.)

How far could you travel (one way) to transport a dog or dogs?                                             

How many dogs could you transport at once?                                                                        


When Are You Able To Transport?
  Week-ends only                                                                                                               
  Days                                                                                                                                 
  Evenings                                                                                                                           
  Any Time                                                                                                                          
  If Specific Days, List:                                                                                                        

Do you have or would you be able to furnish crates for transport if necessary?                     

Do you have full coverage automobile insurance?                Liability?                                    


Read the following carefully.

I declare that the information I have provided in this application is complete and correct. I
further declare that I am financially and physically able to care for a rescue dog,
specifically, a Yorkshire Terrier. I understand that proper food and veterinarian care may
be costly, and I am able and willing to meet the needs of the foster dog. I understand that
the Yorkie Friends Rescue will reimburse me for any pre approved medical expense and
impound fees related to the foster dog. I understand that any food, treats, flea prevention,
and possibly heartworm prevention, toys, beds, collars and leashes, grooming, and travel
expenses associated with the foster dog are a donation and will not be reimbursed. {Yorkie
Friends Rescue is a non-profit organization under section 501c-3, and donations are tax
deductible.}.
I understand the requirements and grant permission for Home Check at random both prior
to and during fostering. I submit that if a Home Check reveal falsification or
misrepresentation of any facts on my part, the Yorkie Friends Rescue reserves the right to
either refuse fostering, to nullify any agreement between us and reclaim said Yorkshire
Terrier from my premises, without reimbursement of the fostering expenses.
I stipulate that I am a volunteer for the Yorkie Friends Rescue. I will provide automotive and
health insurance, and homeowners insurance, and hold Yorkie Friends Rescue and its
officers, members, volunteers, associates, and other foster care providers harmless for any
liabilities, whether damages are physical, emotional, or property, that are a direct or indirect
result of activities associated with fostering, placement, transport, grooming, training, or
evaluating of any Yorkshire Terrier or other dog in any way associated with the Yorkie
Friends Rescue, including any and all activities I perform  as a volunteer for the Yorkie
Friends Rescue.
I understand that Yorkie Friends Rescue Corporation is unable to provide liability
insurance, and that any claims for damages could be filed against my homeowners or car
insurance.
I agree to read the YFR By-laws, Organizational Procedures, and Code of Ethics and will
abide by them. I further understand that a Membership Coordinator will contact me
regarding my acceptance.
My signature confirms that I have read and agree with all
requirements.

Applicants signature:                                                        Date:                                             
Please mail this form to:
Sandy Lester
Yorkie Friends Rescue
503 S Illinois
Prairie DuChien, WI 53821