Application to Become a Foster Care Provider

Please read and fill out carefully this application to be a foster care provider. This form is designed to help us and you decide what your limits are as a foster parent, what you are willing to commit to rescue, and what areas you wish to become involved in. Please read and fill out carefully and answer the questions to the best of your ability. Thank you for your cooperation.

Part I Personal Information

Name:__________________________________________________________________-____

Address:____________________________________________________________________

City:_________________________________________ State: _______Zip:_______________

Telephone (day)_________________________ (evening)_____________________________

Number of adults in household _____________ Men __________Women ________________

Children ____________Boys (ages ) ______ Girls (ages )________

What type of Dwelling: (Circle Appropriate)

Apartment/Apartment-Style Condominium Townhouse Duplex/Triplex

House-Trailer Home Farm Other(if other, please elaborate)

_____________________________________________________________________________

Do you own or rent?_____________________________________________________________

If you rent, do you have the landlord’s permission to keep a dog?_________________________

What areas of Rescue are you interested in? (Check all that apply)

_____Dog Transportation _____Foster Home _____Adoption Screening _____Fund Raising _____Animal Placement _____Referral _____Shelter Contact _____Pick up _____Other______________

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Part II, Environmental Information

How large is your yard? _________________________________________________________

Is it securely fenced? (if “yes” what kind and how tall?) _________________________________

What type of gates? ____________________________________________________________

Can children open the gates?_____________________________________________________

If you have a pool, is it securely fenced? ____________________________________________

If you have a dog run is it secure? _________________________________________________

Are you aware of any dangers that could harm the dog inside the yard? ___________________

If your yard is not fenced, how do you plan to insure that the dog receives safe and adequate exercise? ____________________________________________________________________

____________________________________________________________________________

Where will the dogs sleep? _______________________________________________________

Do you plan to use a Crate? Why or why not? ________________________________________

Will you be keeping rescue primarily indoors or out? ___________________________________

Explain: ______________________________________________________________________

_____________________________________________________________________________

Do you have adequate shelter, such as a doghouse, or kennel area where the dog can take refuge from the elements? _______________________________________________________

____________________________________________________________________________

If not, do you plan to get such shelter before accepting your first rescue? __________________

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Part III Your Pets

Have you ever owned a Scottie before? _____________________________________________

How long? What happened to Him/her? _____________________________________________

Where did you get the dog? ______________________________________________________

Do you have other pets at this time? What kind and sex? ______________________________

If you have other pets, are their vaccinations current? __________________________________

If you don’t have a pet now, have you owned one before? _______________________________

If you have other animals what has been your main problem(s) with them? _________________

__________________________________________________________________________________________________________________________________________________________

If you have other dogs, would you consider them aggressive or submissive to other animals?_____________________________________________________________________

How do you think your other pets would react to a rescue dog? __________________________

_____________________________________________________________________________

Are you prepared to deal with reactions on the part of your pets? _________________________

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Part IV Foster Preferences

Are you willing to foster a Scottie for a short period of time?______________________________

Why do you want to Foster a Scottish Terrier?________________________________________

_____________________________________________________________________________

What area will you be willing to cover with regard to rescue? (please check/circle appropriate)

____City ____County ____Neighboring Counties (Please Name) _______________________

___1/3 State (North, South, Central) _______ ½ State (North, South) ______Statewide

_____Anywhere rescue is needed _______Other

What type of Scottish Terriers will you take? (e.g. only males, only females, only older dogs) ____________________________________________________________________________

Would you be willing to take a dog that did not fit this criteria in an emergency situation? ______

Are you prepared to provide the extensive socialization that is needed to ensure that you have a well rounded Scottie for placement?________________________________________________

Is there any area that you WILL NOT be able to expose a foster dog to?(check all that apply)

_____other dogs _____other people _____small children _____cats ______other pets

_____riding in a car _____housebreaking _____crate training ______obedience training

_____grooming _____ leash training _____being alone in a fenced yard _____nail clipping

_____being alone in a house ______being alone in a car _____other ____________________

What medical considerations will you make in taking a rescue dog? (e.g. won’t take a dog diagnosed with heartworms)______________________________________________________

_____________________________________________________________________________

Are you agreeable to spaying/neutering EVERY dog that you foster? ______________________

Why or why not?_______________________________________________________________

How many dogs are you willing to foster at once? (circle) 1 2 3 0ther__________________

Are you likely to do any training with the foster dog while in rescue?_______________________

What type, and how much? ______________________________________________________

What is your definition of disciplining a dog? _________________________________________

_____________________________________________________________________________

How will you deal with behavior problems in a rescue? (e.g. dog aggression, house soiling)____

_____________________________________________________________________________

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Part V Tough Decisions

Would you be able to handle a dog that comes into rescue only to become sick and have to be euthanised to stop its suffering?___________________________________________________

Are you agreeable to having dogs euthanised because of temperament problems?___________

Why or why not?_______________________________________________________________

_____________________________________________________________________________

If “NO” what would be your alternative solution? ______________________________________

_____________________________________________________________________________

Would you be able to commit the next 12-15 years of your life to any dog you rescue, should a placement not work out and the dog has to come back to rescue?________________________

Are you willing to take Scottish Terrier mixes?________________________________________

How would you handle a situation in which a rescue dog bit you?_________________________

_____________________________________________________________________________

Someone else?________________________________________________________________

Would you be willing to deny an adoptive family a particular dog because the placement didn’t “feel” right? ___________________________________________________________________

_____________________________________________________________________________

Would you be willing to allow us to visit your home? ___________________________________

Do you have the support of your family in view of rescue? _______________________________

Are you willing to work closely with either the rescuing agency, or breed club in making a placement for the rescue dogs?____________________________________________________

Are you financially able to provide adequate food and medical care for the average rescue? ___

_____________________________________________________________________________

Have you emotionally prepared yourself for the sadness that comes when you finally make a placement? ___________________________________________________________________

_____________________________________________________________________________

Are you willing to stay in contact with the adoptive home to ensure that the placement was a success, including follow up visits and/or phone calls? _________________________________

Are you willing to provide counseling/resources to the adoptive family should problems arise later on in the placement?________________________________________________________

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Is there anything else that you want to tell us about your family and its suitability to foster a rescue Scottie? _______________________________________________________________

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

How did you find out about us? __________________________________________________

Your comments or suggestions: ___________________________________________________

Part VI References

Please list three references that can attest to your suitability as a pet owner, and more specifically, a foster parent in Scottie rescue. If you own any pets now, you may include your Veterinarian as a reference.

Reference #1

Address:

City, State, Zip

Phone: (day and evening)

Reference #2

Address:

City, State, Zip

Phone: (day and evening)

Reference #3

Address:

City, State, Zip

Phone: (day and evening)

I, the undersigned, attest that , to the best of my knowledge the above information is accurate and complete at the time of signing, and I understand that falsely provided information can mean that my application will be terminated.

Signature________________________________ Date __________________________

Thank you for filling out this questionnaire, this greatly aids us in knowing what your limitations are and in what capacity that you will best be suited in rescue. Though sometimes it is hard to let go of a rescue dog, we all know that there is another one that could be just as needy if not more just around the corner, and when you are able to make a successful placement the pain is all worth it. Please be aware that foster help doesn’t just end with the placement, nor does keeping the dog in your home constitute all of the needs of rescue. Every individual is suited to a different aspect of rescue, and we will work with you to assign you in a capacity where you are comfortable and can make a difference. Thank you for your cooperation.

Please return this form at your earliest convenience to:

Scottish Terrier Rescue of North Alabama

Bettina Rister

1616 Enolam Blvd. SE

Decatur AL, 35601

If you have any problems or questions about this form, please call anytime: 256-351-1862.