Please fill out the form completely.

Personal Information

Date:

Your full name:

Age:

Spouse's full name:

Address:

City, State, Zip:

Phone (H): (W):

E-mail Address:

How often do you check your e-mail: Select Daily Weekly Monthly Other

Occupation:

Years there:

Including commute, how many hours per day will the dog be alone?

Daily hobbies/activities:

Does anyone in your family have pet allergies? Select No Yes

Please list the names and ages of all people residing in your household:

Type of dog you are interested in fostering

Which do you prefer to foster: Select Male FemaleNo Preference

Age preference (check all that apply): less than 1 year 1-3 years 4-7 years 8 years and older doesn't matter

Please tell us a little about yourself and why you want to foster Border Collies.

Your home and yard

Do you live in: Select HouseApartment Condo Other

How long have you lived there?

Approximate size of yard:

Do you rent or own? Select Rent Own

Landlord's name, address and phone number (required)

If you rent, does your rental agreement permit pets? Select No Yes

Does your rental agreement have a size limit on a dog? Select NoYes If so, how many lbs.?

Are there any ordinances limiting the number of dogs you can have on your property? Select NoYes If yes, how many?

Is your property fenced? Select NoYes If yes, what type/height is the fence?

If not, how when and where will you exercise your foster dog?

Does your home have an outside kennel or other facility with shelter or doghouse for the temporary housing of restricted dogs? Select No Yes

Where will the dog spend it's time alone? (Please be specific)

Where will the dog spend it's time at night? (Please be specific)

Care and training of the foster dog

Would your dog be living with or have any of these neighbors/visitors, or encounter any of these situations/activities regularly? (Check all that apply)

Who will provide the majority of care for the foster dog?

What activities or work will your foster dog have?

Have you ever participated in an obedience class? Select NoYes

How do you feel about using dog crates?

When you go on vacation, where will your foster dog go and who will care for it?

How long do you feel a foster dog needs for an adjustment period once placed in your care?

Are you and your family willing to work with a foster dog on any issues that he/she may have or develop? Select NoYes

What behaviors would you have a hard time dealing with in a foster dog? (check all that apply)

Your Other Animals

Please list all other animals you have owned in the last ten years (living or deceased)

Do any of your current pets have a medical conditions? Select No Yes

If yes, please explain

How do you exercise your dog(s)

Other Information

How did you hear about us?

Have you ever applied to adopt a dog from us? Select Yes No

If yes, when and which dog?

Are you willing to allow a home visit by appointment? Select YesNo

Have you ever been bitten/attacked by a dog? Select Yes No  If yes, please explain

How will you confine the foster dog during periods of your absence?

Do you intend to keep your foster dog primarily... Select Indoors Outdoors Combination

Are you comfortable approaching dogs that you do not know? Select YesNo

Do you understand that dogs may be unpredictable and that MWBCR cannot guarantee that a dog we are attempting to rescue may become aggressive? Select Yes No

Are you willing to accept any risk involved with working with animals that are sometimes frightened andin unfamiliar surrounds may become aggressive? Select Yes No

Are you willing to accept any risk involved in transporting a dog inside your vehicle? Select Yes No

Are you willing to foster a special needs (medical/health/emotional issues) dog with guidance from MWBCR? Select Yes No

Are you willing to foster a dog that is not housebroken? Select Yes No

What type of services have you performed in the past/present?

Please give any other information about yourself that you feel is relevant or important.

References

Please list four (4) people who have known you for at least two years. We recommend your vet, dog trainer, neighbor, personal friend, co-worker. No more than one family member may be listed. Please list name, phone number, address, email address and relationship to you.

1.Name of Vet:

Phone Number:

Address:

2.Name:

Relationship to you:

Phone Number:

Address:

E-mail Address:

3.Name:

Relationship to you:

Phone Number:

Address:

E-mail Address:

4.Name:

Relationship to you:

Phone Number:

Address:

E-mail Address:

Emergency Contact: Please give us the name and phone number for a person not living with you.

I hereby affirm that all of the above information is true and correct. I understand that submission of this application does not necessarily mean that I will be approved to foster and that MWBCR reserves the right to reject any applicant. I authorize MWBCR to verify any and all information set forth in this application and to contact my personal references. I agree to provide any records to MWBCR of all Border Collie owned by MWBCR that are in my care. Select Yes No

I understand that dogs may be unpredictable and MWBCR cannot guarantee nor warrant that a Border Collie we are attempting to rescue may become aggressive. I am willing to assume the risks involved with working with animals that are sometimes frightened and may become aggressive. I agree to assume all risks implicit in working with dogs that have come into the care of Midwest Border Collie Rescue, Inc. I understand that dogs can be destructive and a foster dog may cause damage to my property. I am willing to accept that risk and will not seek reimbursement from MWBCR for any damage. Select Yes No

Please contact your vet and let them know we will be calling. Without your consent, your vet may not release information to us.

Initials