PERSONAL INFORMATION

* NAME:

* ADDRESS:

* COUNTY: Alachua Baker Bay Bradford Brevard Broward Calhoun Charlotte Citrus Clay Collier Columbia DeSoto Dixie Duval Escambia Flagler Franklin Gadsden Gilchrist Glades Gulf Hamilton Hardee Hendry Hernando Highlands Hillsborough Holmes Indian River Jackson Jefferson Lafayette Lake Lee Leon Levy Liberty Madison Manatee Marion Martin Miami-Dade Monroe Nassau Okaloosa Okeechobee Orange Osceola Palm Beach Pasco Pinellas Polk Putnam Sumter Seminole St. Lucie Sarasota Suwannee St. Johns Santa Rosa Taylor Union Volusia Wakulla Walton Washington

* CITY: * STATE: Florida Georgia Alabama Louisiana Other * ZIP:

* HOME PHONE: WORK PHONE: CELL PHONE:

* E-MAIL:

PLANNING ON MOVING IN THE NEXT... 3 Months 6 Months 1 Year Over 1 Year Not Moving

IF MOVING, DO YOU PLAN ON MOVING OUT OF STATE IN STATE

YOUR AGE RANGE: Under 18 18-20 21-25 26-35 36-45 46-55 56-65 66-75 Over 76

FOR STATISTICAL PURPOSES, WHAT ARE THE OCCUPATIONS OF ALL ADULTS IN THE HOUSEHOLD:

ARE YOU OR YOUR SPOUSE WITH THE MILITARY? YES NO

IF YOU ANSWERED YES TO BEING IN THE MILITARY ARE YOU.. ACTIVE INACTIVE/RETIRED

IF YOU HAVE APPLIED TO ADOPT FROM OTHER RESCUES PLEASE NAME THEM.

VET'S INFORMATION (Most Recent in past 2 years.)

Vet's NAME:

Vet's ADDRESS:

Vet's PHONE NUMBER:

Vet's EMAIL ADDRESS:

IF YOU HAVE USED THIS VET FOR 1 YEAR OR LESS, PLEASE PROVIDE PREVIOUS VET INFORMATION:

MAY WE CONTACT YOUR VET? YES NO

IF YOU DO NOT HAVE A VET, HAVE YOU LOOKED INTO VETS IN YOUR AREA FOR THE NEW DOG? YES NO

DO YOU GET ANNUAL SHOTS FOR YOUR PETS? YES NO

DID YOU READ THE HEARTWORM SECTION OF OUR EDUCATION PAGES? YES NO

DO YOU GET AN ANNUAL HEARTWORM TEST ON YOUR PETS? YES NO

DO YOU GET AN ANNUAL PHYSICAL EXAM FOR YOUR PETS? YES NO

DID YOU READ THE FLORIDA'S PARASITES SECTION OF OUR EDUCATION PAGES? YES NO

DESCRIBE YOUR ANNUAL VET VISIT, I.E. For shots, routine physical, etc.

ARE YOUR CURRENT PETS SPAYED/NEUTERED? YES NO

DO YOU USE HEARTWORM PREVENTATIVE? YES NO

IF YES WHAT BRAND? ..... None Heartgard Interceptor Sentinel Revolution ProHeart 6 (6 mth shot)

DO YOU USE FLEA/TICK PREVENTATIVE? YES NO

IF YES WHAT BRAND? ..... None Frontline Advantage Program Revolution K9 Advantix

PAST EXPERIENCE AND TRAINING

HAVE YOU EVER BEEN BITTEN OR ATTACKED BY A DOG? YES NO

DID THE BITE REQUIRE MEDICAL ATTENTION? YES NO

IF THE BITE REQUIRED MEDICAL ATTENTION, PLEASE EXPLAIN:

ARE YOU COMFORTABLE APPROACHING A DOG YOU DO NOT KNOW? YES NO

DO YOU UNDERSTAND THAT DOGS MAY BE UNPREDICTABLE AND THAT SHRF, INC. CANNOT GUARANTEE THAT A DOG WE ARE ATTEMPTING TO RESCUE WON'T BECOME AGGRESSIVE? YES NO

ARE YOU WILLING TO ASSUME THE RISKS INVOLVED WITH WORKING WITH ANIMALS WHO ARE SOMETIMES FRIGHTENED AND WHO ARE IN UNFAMILIAR SURROUNDINGS AND THE POSSIBILITY THAT THE DOG MAY BECOME AGGRESSIVE AND/OR BITE YOU OR A COMPANION? YES NO

DO YOU HAVE EXPERIENCE/TRAINING IN ANY OF THE FOLLOWING DOG-RELATED AREAS OF WORK?
(check all that apply)

Breeding

Grooming

Kennel Assistant

Animal Rescue

Training

Vet Tech

Pet Store Sales

OTHER EXPERIENCE AND SKILLS THAT WOULD HELP YOU IN RESCUE:

PLEASE DESCRIBE THE NATURE AND EXTENT OF ABOVE WORK/TRAINING EXPERIENCE?

PLEASE EXPLAIN OR DESCRIBE ANY OTHER INFORMATION WHICH YOU FEEL IS RELEVANT OR IMPORTANT ABOUT YOURSELF:

WHAT TYPE OF SERVICES HAVE YOU PERFORMED IN THE PAST, OR ARE PERFORMING NOW, FOR OTHER VOLUNTEER AGENCIES?


PLEASE LIST DOG CLUBS/RESCUE ORGANIZATION MEMBERSHIPS PAST AND PRESENT:

PLEASE LIST POSITIONS HELD OTHER THAN GENERAL MEMBER:

RESIDENCE INFORMATION

HOME STYLE: ..... Single Family Home Multi Family Home Townhouse Condominium Mobile Home Apartment DESCRIBE YOUR COMMUNITY: ..... Suburban Urban Rural

DO YOU HAVE AND CAN YOU PROVIDE PROOF OF HOMEOWNERS INSURANCE? YES NO

DO YOU HAVE A FENCED IN YARD? YES NO

IF YES PLEASE DESCRIBE:

HOW MANY PEOPLE LIVE IN YOUR RESIDENCE?

HOW MANY CHILDREN LIVE WITH YOU OR VISIT FREQUENTLY?

DO YOU OWN OR RENT/LEASE? OWN RENT/LEASE

ANY DEED RESTRICTIONS? YES NO

IF YOU RENT OR HAVE DEED RESTRICTIONS PLEASE GIVE THE FOLLOWING:
(*Note: A letter from your landlord indicating a dog of this size is authorized in your home will be asked for. Your application cannot be processed without this information)

LANDLORD/PROPERTY MANAGER'S NAME:

LANDLORD/PROPERTY MANAGER'S ADDRESS:

LANDLORD/PROPERTY MANAGER'S PHONE NUMBER:
NOTE: We will be contacting your Landlord for a verbal approval also.

ARE YOU ALLOWED PETS OVER 50 LBS? YES NO

PET OWNERSHIP INFORMATION

PLEASE LIST ALL PETS OTHER THAN DOGS AND CATS:

HAVE THESE PETS INTERACTED WITH DOGS? YES NO

HOW MANY DOGS DO YOU CURRENTLY OWN?:

PLEASE LIST ALL YOUR DOGS NAMES, AGE AND BREED:

HOW MANY DOGS HAVE YOU OWNED IN LAST 10 YEARS?

BRIEFLY DESCIBE WHAT HAPPENED TO THE DOGS YOU NO LONGER HAVE:

HOW MANY CATS DO YOU CURRENTLY OWN?

ARE THE CATS DECLAWED? YES NO

IS YOUR CAT AN INDOOR OR OUTDOOR CAT? INDOOR OUTDOOR INDOOR AND OUTDOOR

HAVE YOUR CAT(S) INTERACTED WITH DOGS? YES NO

IF YES, PLEASE DESCIBE YOUR CAT(S) INTERACTIONS WITH DOGS:

HOW DO YOU FEED YOUR PETS:

HOW WILL YOU INTRODUCE THE NEW DOG TO YOUR FAMILY AND CURRENT PETS:

IF YOU CURRENTLY HAVE DOGS, HAVE YOU READ THE MULTIPLE DOG SECTION OF OUR EDUCATION PAGES?
YES NO

HAVE YOU DONE ANY RESEARCH ON SIBERIAN HUSKIES? (check all that apply below) YES NO

I HAVE OWNED A SIBERIAN HUSKY I HAVE READ BOOK(S) ABOUT THE BREED

I HAVE DONE RESEARCH ON THE INTERNET I HAVE READ THE SHRF HUSKY EDUCATION PAGES

A FAMILY MEMBER OWNS A SIBERIAN HUSKY A FRIEND OWNS A SIBERIAN HUSKY

I HAVE TALKED TO PEOPLE WHO OWN HUSKIES

HOW WOULD YOU DEAL WITH A DOG THAT SHEDS A LOT?

HOW MANY HOURS A DAY WILL THE DOG BE ALONE?

WHERE WILL THE DOG BE KEPT WHEN NOBODY IS HOME? INDOORS OUTDOORS CRATE KENNEL RUN BACKYARD BACKYARD W/ ACCESS TO GARAGE OR ROOM FREE ROAM OF THE HOUSE
You can select multiple items by holding the "CTRL" button down

WHERE WILL THE DOG BE KEPT AT NIGHT? INDOORS OUTDOORS CRATED KENNEL RUN FREE ROAM OF HOUSE A DOG BED OUR BED BEDROOM FLOOR WHEREVER IT WANTS
You can select multiple items by holding the "CTRL" button down

ARE YOU WILLING TO CRATE TRAIN THE FOSTERED SIBERIAN? YES NO PREFER NOT TO CRATE

ARE YOU WILLING TO DO BASIC OBEDIENCE TRAINING WITH THE FOSTERED SIBERIAN? YES NO

WHAT WOULD YOU DO IF A PROBLEM ARISES WITH THE FOSTERED SIBERIAN?

WHAT WOULD YOU DO IF THE FOSTER SIBERIAN GOT LOST OR STOLEN?

HAVE YOU EVER BEEN CONVICTED OF ANIMAL CRUELTY OR HAD A COURT ORDER AGAINST YOU PREVENTING YOU FROM OWNING OR BEING NEAR ANY ANIMALS, EVEN FOR A SHORT PERIOD OF TIME? YES NO

IF YES, PLEASE DESCRIBE:

TYPE OF FOSTERING

Please indicate which types of fostering you are interested in: (Check all that apply)

TEMPORARY - approx. 1-3 days, these foster homes would be needed in cases where there is a timing issue associated with transport or for a scheduled adoption.

SHORT TERM - approx. 1-2 weeks; these foster homes would be needed in cases of vacations by other foster homes, some timing issues.

SURGICAL - approx. 2-6 weeks (may be longer depending upon the surgery); these foster homes would be needed in the cases of surgery recoveries, e.g. recovering from spay/neuter. Please note that if you have other pets you may need to have the facilities to keep the foster dog separate during the recovery time.

BEHAVIORAL - approx. 1-4 months (time may vary depending on the severity of the case); these foster homes would be needed in the cases where behavior modification is needed in order to make the dog adoptable. The organization has a behavioral trainer evaluate the dog and work closely with these foster homes. Please note that if you have other pets, you may need to have the facilities to keep the foster dog separate during the training time. SHRF will work to make the dogs in our care adoptable, but it is understood that there are some cases in which we are unable to help. In such cases, SHRF’s policy will be consulted.

CONTINUAL - these foster homes are willing to foster a dog until such time as the dog is adopted. The time may vary anywhere from 1 day to 6 months. The foster home will then have the opportunity to foster another dog once the original dog has been adopted.

FOSTERING FACILITIES

DO YOU HAVE AN OUTSIDE KENNEL OR OTHER FACILITIES FOR THE TEMPORARY HOUSING OF RESTRICTED DOGS?
YES NO

IF YES, PLEASE DESCRIBE:

IF YOU CURRENTLY OWN A DOG(S), IS IT NECESSARY FOR THE FOSTER DOG TO GET ALONG WITH THEM?
YES NO

IF NO, DOES YOUR HOME HAVE ANY MEANS FOR SEPARATING A FOSTER DOG FROM YOUR DOG(S)? YES NO

DESCRIBE:

IF YOU CURRENTLY OWN A CAT(S), IS IT NECESSARY FOR THE FOSTER DOG TO GET ALONG WITH THEM?
YES NO

IF NO, DOES YOUR HOME HAVE ANY MEANS FOR SEPARATING A FOSTER DOG FROM YOUR CAT(S)? YES NO

DESCRIBE:

THE SIBERIAN TO BE FOSTERED

WHAT SEX DO YOU PREFER?: MALE FEMALE NO PREFERENCE

WHAT AGE ARE YOU WILLING TO ACCEPT?: SENIOR AGES 7 AND UP ADULT AGES 4-6 YEARS YOUNG ADULT AGES 1-3 YEARS PUPPY AGES 6-11 MONTHS NO PREFERENCE

CHARACTERISTICS NEEDED TO BE IN YOUR HOME: HOUSEBROKEN PRESCHOOL CHILDREN SCHOOL AGE CHILDREN TEENAGERS SENIORS GOOD W/SMALL DOGS GOOD W/LARGE DOGS GOOD W/CATS GOOD W/LIVESTOCK
You can select multiple items by holding the "CTRL" button down

WHY DO YOU WANT TO FOSTER A SIBERIAN HUSKY?

REFERENCES (*We need at least 3 references not related to you, i.e. other pet friends, pet sitters, long term friends, co-workers, etc.)

3 references MUST be completed including phone numbers or your application will be denied!

NOTE: Family members (living with you or not) are NOT acceptable as references and will cause a significant delay in the processing of your application

* REFERENCE #1:

* REFERENCE #2:

* REFERENCE #3:

Section F

By filling out this Foster Application I/we the undersigned are aware that this does not guarantee me/us a foster position from Siberian Husky Rescue of Florida, Inc. If I/we are accepted I will remember in all my dealings with the public that I represent SHRF, Inc. and will act pleasantly and answer questions politely or refer persons to someone who can. If I/we are not accepted to be a Foster I/we will not misrepresent myself/ourselves as a foster and collect donations, applications or do any other activity Siberian Husky Rescue of Florida, Inc., as an organization, is involved in or participates in.

Would you you be willing to sign a 'waiver and releases of liability' if you are approved to be a volunteer for SHRF? YES NO

Do you have and can you provide proof of a valid FL driver's license? YES NO

Do you have and can you provide proof of valid auto insurance? YES NO

I have accurately completed this questionnaire, have read the above warning, and appreciate the risks in working with rescue dogs. I understand that SHRF, Inc. cannot be responsible for the actions, behaviors and/or medical condition of the dogs that it seeks to rescue and I agree to assume the risks implicit in working with dogs, which may have been abandoned, beaten, otherwise mistreated, or abused or who may suffer from an illness, condition or disease.

* SIGNATURE OF APPLICANT:

DATE:

SIGNATURE OF CO-APPLICANT:

DATE:

NOTE: Items indicated by * MUST be completed to submit this form. To submit this application please click the submit button below and you will get a verification screen that the application was submitted. If you do not get the verification screen your application did not submit, please try it again. If you do not receive a reply from us within 48 hours please call 727-391-8934.