How did you hear about Northeast Border Collie Rescue?

Please list the adults in your household, their relationship to you, their occupations and their ages:

If fostering, do they agree with and support  your decision? Yes No

If not, please explain:

Are there children in your household? Yes No

If yes, please list their ages:

If fostering, will they be responsible for caring for this dog? Yes No

Are there children in your neighborhood? Yes No

Are you frequently visited by children? Yes No

Do any children have access to your yard/kennel/house when you are not at home? Yes No

If yes, please explain how you intend to prevent them from teasing a dog, letting a dog out either intentionally or accidentally, or doing anything that might be detrimental to the welfare of a dog in your care.

Is anyone in your home allergic to animals?  Yes No

Is anyone in your home afraid of dogs?  Yes No

Is anyone in your home elderly or frail? Yes No

Your Neighborhood

Is your neighborhood  Rural Suburban Urban

Do you you live in  Apartment  Condo Mobile Home Single-Family Home Military Housing

Do you  Own  Rent  your property?

If you rent, do you have permission from your landlord to have pets on the property? Yes No

Do you live in a development or other area where there are houses nearby? Yes No

Do you share a house with other families? Yes No

Are there neighbors nearby who would be upset by a barking dog? Yes No

Are they aware that you intend to adopt a dog? Yes No

Are there any restrictions to the number of dogs and /or cats or combination that you may have at your residence? Yes No

If yes, please explain:

How large is your property?

Do you have cats or other animals living in your house? Yes No

If yes, what kind and how many?

Is there a busy road nearby? Yes No

Do you have a fenced  yard or outdoor kennel? Yes No

Please describe any fencing, including its height, and the size of the area it encloses:

Are you required to obtain a kennel license if you take in dogs in addition to your own?

Yes No

If yes, are you willing to obtain such a license?  Yes No

Your Experience With Dogs

How many years have you owned/been involved with dogs?

Please give a brief history of the previous dogs you have owned:

Please describe your experience with Border Collies:

Your Current Dogs

Do you own a dog now? Yes No

Please describe each dog you own . Please include breed, age, size and temperament, particularly with regards to other dogs:

Have you ever been bitten or attacked by a dog? Yes No

If yes, please explain:

Are you comfortable approaching unfamiliar dogs? Yes No

Please list the names, phone numbers and /or email addresses, and their relationship to you and your dogs of three people who are knowledgeable about you and your care of dogs (i.e. trainer, kennel owner or groomer) Please include your vet as one of these references.

How You Are Able to Assist NBCR

Please check all that apply:

Home visits to evaluate potential adopters and their environment

Post-adoption follow-up visits and phone calls

Evaluation of dogs for acceptance into NBCR (training will be provided)

Public education (i.e. staffing tables) at various events

Demonstrations of sports, herding, flyball, free style and/or other events with Border Collies

Meet with local shelters, vets, etc and distribute NBCR literature

Provide transportation of dogs within a mile radius of my home

Assist with photocopying, mailing, computer services, editing, telephone, etc

Other. Please describe:

I am a:

Vet

Vet Tech

Trainer

Animal Behavior Consultant

Groomer

Other animal professional/specialist:

I am willing to offer free or discounted services to NBCR and /or NBCR's volunteers. Please be specific:

I am willing to help my rescue workers/foster homes by dog walking, kennel cleaning, dog sitting, etc. Please be specific:

If fostering, do you own a crate/s Yes No

If yes, what type, what size and how many:

If fostering, how many foster dogs are you able to foster at a time?

If fostering where will you house your foster dog/s while with you?

For All Foster Home Applicants

Care and training provisions:

Are you willing to take responsibility for assuring that a dog in your care is given all the health care it needs, including spaying/neutering, vaccinations, de-worming, Heartworm/Lyme Disease testing, preventative and treatment, if necessary? Yes No

Please check each area in which you feel comfortable assessing:

A dog's temperament for an ordinary household

Suitability for placement in a home with children 10 years or older

Suitability with children younger than ten including toddlers and infants

Suitability for placement in a home with other dogs

Suitability for placement for placement in a home with cats or other animals. Please be specific:

Reaction to a variety of experiences

Suitability for dog sports

Evaluation of herding instinct

Other. Please specify:

Please check the level of training you are able to provide a foster dog:

Socialization with other dogs

Socialization with other animals

Socialization with children of various ages

Socialization with strangers, delivery people, etc

Housetraining

Crate Training

Walking on a leash

Basic training including: sit, down, stay and heel

More advanced training such as obedience, sports or herding

Please describe the training methods you use:

Do you have the experience to handle dogs with severe behavioral problems (i.e. aggression, fear biting, etc)?

Yes No  If yes, please explain:

Foster Volunteer's Relationship With Their Rescue Supervisor

Are you willing to assume the risks involved with working with animals who are sometimes frightened and in unfamiliar surroundings who may become aggressive? Yes No

If no, please explain:

Are you willing to commit to fostering a dog for as long as it takes to place it?

Yes No  If no, please explain:

Volunteer and Foster Home Contract

By signing the following contract you agree to abide by the rules and policies of NBCR.  Failure to abide by these rules and policies will cause your termination from NBCR.

I, ,

as a Volunteer and/or Foster Home, agree to abide by NBCR's policies and rules.  I, furthermore, agree to the following items that I have initialed or checked.

I agree to work with a rescue supervisor and to abide by any decisions made by him/her.

I understand that my rescue supervisor has the ultimate responsibility for each dog and the right to place it as he/she feels appropriate.

I will treat all Border Collies in my care humanely.

I will never falsely represent myself, NBCR, or any NBCR dog in my care.

I will never sell a NBCR rescue dog that comes into my care, or otherwise profit from Northeast Border Collie Rescue.

I will not knowingly give any NBCR dog to a research facility, pet shop, dog broker, puppy mill, dog breeder for purposes of breeding,or to any other person, firm, corporation or organization that may cause harm either mentally or physically to any NBCR dog that has been in my care.

I will never use NBCR's name in order to sell a dog or puppy of my own.

I will never use a NBCR dog in my care for breeding purposes.

No NBCR dog will leave my care that has not been spayed/neutered unless I have provided in some way for its spaying/neutering, either by written contract with the new owner or by some other method approved by my rescue supervisor.

I have read, understand and agree to abide by NBCR's policies and rules governing volunteering and fostering for NBCR.

Signed:

Date: