Volunteer Application

Personal information: (must be completed in it's entirety)
Name:
Age:
Street Address:
City:
State:
Zip:
How long have you been at this address:
Previous address, if less than 2 years:
How long were you at previous address:
Home Phone:
Best time to reach at home:
Work Phone:
Best time to reach at work:
Email Address:
Cell Phone:
Fax:
Employer:
Occupation:
Spouse/Partner's Name:
Spouse/Partner's Age:
Spouse/Partner's cellphone:
Spouse/Partner's Employer:
Spouse/Partners Occupation:
Number of children living in your home:
Ages and Relation to you:
Please list everyone in your home not mentioned above, relation to you, and their ages:
Living Environment (must be completed in it's entirety)
Please select the term(s) that best describe your current living situation:	House Condo Apartment Modular Home
Home ownership:

Landlord's Name:
Landlord's Phone Number:
Social Environment:
Does your home have a backyard:
Is your backyard fenced:
Fence Type:
Fence Height:
Is fence permanent:
Is the edge of the fence buried to prevent tunneling:
Will the gate be padlocked:
Do you have a pool or pond:
If so, please explain precautions taken to keep pets out of drowning danger:
Volunteer Information (must be completed in it's entirety)
I have experience and/or am willing to help in the following areas:
Yorkie Shoppe:	Sewing skills Crocheting skills Knitting skills Baking skills Provide supplies for the above crafts
Verbal Communication Skills:	I would like to do applicant screening I would like to do reference and vet check calls I would like to do fund raising
Rescuing/Transporting:	I have contacts with the local shelters and Humane Society I would like to be involved in transporting dogs for placement I am willing to do initial home visits with potential adopters I am willing to do follow-up home visits with adopters
Other skills and talents or ways I can contribute to United Yorkie Rescue’s efforts including any computer skills:
Have you worked with any other rescue organizations in the past? If so, name of organization(s):
Are you currently affiliated with any other rescue organizations? If so, please list organization(s) and in what capacity you volunteer:
Have you ever fostered any animal before:
What agency did you foster for:
Foster agency's phone number:
Explain the details of your previous fostering:
Foster and Care Information
Are you able to foster:
Why or why not able to foster:
Are you willing to foster a dog until a permanent home can be found:
If not, are you able to foster temporarily until transportation can be arranged to a foster home:
Maximum time frame you are willing to temporarily foster for (temporary placement is usually no more than 7 days):
Is everyone in your home agreeable to fostering a Yorkshire Terrier:
If not, who and why:
Will the dog be left alone during the day:
How long will it be left alone:
Specifically, what will be the dog's living situation? (Examples: run of house, or a restricted area):
If dog will be kept outside, describe kennel, house, etc:
Is it heated and/or cooled:
If you have a preference of male or female, specify:
Age range preference:
Medical condition(s) you are unable to handle:
Will you provide transportation of dog for veterinary, adoption, and etc purposes:
Veterinarian you will employ, name and phone:
Would you be willing to discuss with your vet the possibility of a discount for the rescued yorkie:
Would paying for medical expenses and being reimbursed later be a hardship:
Would you be able to quarantine a dog if necessary:
If you are able to quarantine, please explain:
Current & Previous Pets
Have you ever owned a Yorkshire Terrier:
If so, where is it now:
Do you have other pets:
Pets breeds, ages, and sexes:
Are all pets current of all vaccinations:
Are all other pets spayed/neutered:
If not current on vaccinations or spayed/neutered, please explain:
Are other pets on heartworm preventative:
Heartworm preventative brand:
If not on heartworm preventative, please explain:
Approximate date of last Veterinarian visit for each pet:
Have any of your current pets shown aggression or bitten a person:
If yes, please explain the circumstances of the agression toward a person:
Have any of your current pets ever shown aggression or bitten a pet?:
If yes, please explain the circumstances of the agression toward a pet:
List all pets you've owned in the last 10 years, not mentioned above, and their present status:
Have you ever taken a dog to a professional trainer or behaviorist:
If so, how did this behaviorist/trainer work out for you/pet:
We will provide you with an evaluation of the foster Yorkshire Terrier's temperament based on the information provided to us by the surrendering owner or information provided by the shelter where the yorkie came from.
Will you be willing to work with us to correct any possible behavior problems:
Do you understand that often times the complete history of a rescue Yorkshire Terrier may not be known:
References
Veterinarian name, address, and phone number:
Vet fax number:
Secondary vet name and any other vet you may have seen in the last 5 years, address, and phone number:
Groomer name, address, and phone number:
Please provide the name, address, and telephone number of three (3) references and their relationship to you. Please only include one (1) family member.
Reference 1:
Reference 2:
Reference 3:
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 foster 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 UYR Treasurer will reimburse me for pre-approved expenses after submitting a copy of the bill with the foster dog's name and ID# to the Foster Coordinator. The Treasurer will also reimburse me for any pre-approved medical expenses and impound fees related to the foster dog. Pre-approval will come from your State Director or Regional Coordinator. I understand that any food, toys, and travel expenses associated with the foster dog are a donation and will not be reimbursed. I understand the requirement and grant permission for Home Checks at random, both prior to and during fostering. I submit that if a Home Check reveals falsification or misrepresentation of any facts on my part, the Facilitator or representative 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 applying herein to become a volunteer for United Yorkie Rescue and I will provide automotive, homeowners and health insurance, and hold United Yorkie Rescue or its representatives, its officers, members, volunteers, associates, or 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 placement, transport, grooming, training, or evaluating of any Yorkshire Terrier or other dog in any way associated with United Yorkie Rescue, including any and all activities I perform as a volunteer for United Yorkie Rescue. I further understand that either my Regional Coordinator or State Director will contact me regarding my acceptance. If accepted, I understand the first six months my membership will be probationary, and my membership may be dissolved immediately without cause if the Board of Directors deems my intentions or actions to be in conflict with the mission and vision of United Yorkie Rescue.
Applicant's Signature: