Pekingese Rescue and Re-homing

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Volunteer Application

This application form is intended to be a guide for us to consider ways you might be able to assist our organization as a Volunteer. This is by no means meant to be a test that will be used to disqualify you from consideration for helping one of our dogs. Please give some thought to each question on this application as you answer them. Occasionally we experience delays in processing applications. We appreciate your patience as we have no paid staff and our volunteers work hard trying to keep delays to a minimum.

You must TAB or use your mouse to navigate through this form. If you use the spacebar or press ENTER, it will submit an incomplete application.

Please note that an application that contains incomplete information or insufficient references can result in delayed processing or disqualification. Thank you.

What area would you like to volunteer your time?

Home fostering
Transportation of dogs
Telephone calling for reference checks
Personal interviewing and home visits of adopting candidates
Fundraising
Other Please describe:

Please Note:

If you are interested in volunteering your time to any of the above-noted positions, EXCEPT home fostering, please complete Part A only.

If you are interested in volunteering your time to any of the above-noted positions, INCLUDING home fostering, please complete Part A and Part B.

PART A

Your name:
Your age:
Email address:
Home phone:
Business phone:
Cell phone:
Address (street/city/state/zip):
Your profession:
Your spouse's profession:

Are you associated or currently working with any other rescues?
Yes No
If yes, which rescue(s)?

Have you ever been convicted of abuse or neglect towards an animal?
Yes No

Any covenants or restrictions that prevent you from being in contact with animals?
Yes No

Do you have a valid driver's license?
Yes No

When and what amount of time are you able to devote to volunteering for us?

95% of our corresponding and the communication amongst the volunteers is done by email. Do you have access to a computer, and are you able to check it often to keep in touch?
Yes No

PART B

Do you have any experience with fostering a homeless animal?
Yes No

Although it is preferable to foster only one dog at a time, sometimes we get bonded pairs or multiple dogs. How many dogs do you think you can you foster at one time?

How long are you willing to take responsibility for a foster dog?

Short term (three months or less)

Long term (three months or more)

For emergencies or over-night transports only

Some foster homes deal with behavior issues, which may include things such as house training, excessive barking, fear of children, extreme shyness, submissive wetting, marking territory, aggression or nipping. Do you have experience with these issues?
Yes No

Would you be willing to deal with these issues in a foster dog?
Yes No Maybe

Under the following conditions:

With our help, are you willing to provide training to resolve behavior problems?
Yes No

Dogs that come from a puppy mill or that have a history of neglect or abuse may have very different behavior patterns than dogs that are surrendered by an owner. Have you dealt with these issues in dogs before?
Yes No

Do you feel you are capable and prepared to deal with any behavior issues by providing patience and understanding?
Yes No Maybe

Under the following conditions:

Are you willing to accept a dog that is old or has special needs such as being blind, deaf, epileptic, arthritic, has allergies, cannot climbs stairs or has back problems?
Yes No Maybe

Under the following conditions:

Would you be willing to accept a dog that has treatable medical problems, and be willing to administer eye drops, ear drops, allergy medicine, diabetes medicine, heart medicine, epilepsy medicine, heartworm treatment, or other medicines or treatments?
Yes No Maybe

Under the following conditions:

Do you have pets? Yes No

If yes, how many? Cats Dogs Other

Tell us about each of your current pets (gender/age/breed/age when acquired, etc.):

Tell us about their temperament (such as whether they are dominant or submissive, active or lazy, independent or timid, etc.):

Are they spayed and/or neutered? Yes No
If no, please explain:

Can you isolate the foster dog from your other pets initially or in the event they cannot get along? Yes No
If yes, please explain:

Please Note:

All animals in your home must be vaccinated against rabies and distemper to qualify for this program. It is also highly recommended that all cats are vaccinated against Feline Leukemia and all dogs are vaccinated against Bordetella.

Are all your pets up to date on their shots and vaccinations? Yes No

Heartworm preventative medicine? Yes No

Flea control? Yes No

If no, to any of the above three questions, please explain:

We will need to confirm with your veterinarian about your current pets. Please provide the following information:

Clinic name:
Doctor's name:
Address (street/city/state/zip):
Phone number:
Email address (if known):

What type of home do you live in?
House Apartment Condo Duplex Mobile Home

Please describe your home:

Do you own or rent? Own Rent

If you rent, are you permitted to have pets in your home? Yes No

Please provide us with your landlord's information, if applicable:

Landlord's name:
Address (street/city/state/zip):
Phone number:
Email address (if known):

Do you have a safe and securely fenced yard without holes?
Yes No

If you do not have a fenced yard, how do you plan to have the dog relieve itself or exercise?

What percentage of time will the foster dog be in the following?
House: %
Yard: %
Other: %

How many hours a day are you away from home?

Where will the foster dog be during this time? Please describe in great detail. For instance, will you be using a crate and for how long?

Where will the dog sleep at night?

Gender preference:
Male Female Doesn't matter

Age preferred:
Puppy Young adult (1-3 years) Adult (4-7 years)
Senior (10+ years) Doesn't matter

It is not always possible to determine the exact age of a rescue dog. Are you willing to foster a dog that is presumed to be in the age bracket that you have specified?
Yes No

Dogs require regular, routine grooming, regardless of whether the coat is left long or is in a puppy cut. What are you able to do?

Daily brushing: Yes No
Occasional bath: Yes No
Nail trimming: Yes No
Ear cleaning: Yes No
Coat trimming: Yes No

All our dogs will be altered and brought up-to-date on shots and vaccinations prior to entering their foster homes. PNC Midwest Rescue will cover all dental and medical expenses required for the dog while in foster care, but do you understand that you will be responsible for out-of-pockets expenses such as food, toys, gas for traveling, etc.?
Yes No

Do you understand that the dog you foster is the possession of PNC Midwest Rescue and you agree to follow our guidelines for its care?
Yes No

Do you understand that you are expected to review applications and participate in the selection of the forever home of your foster dog?
Yes No

Do you understand that we will need to arrange an appointment to visit you (and all your family members) at your home prior to you fostering one of our dogs?
Yes No

Please list family members and their ages:

Do you or any member of your family have any on-going medical conditions or physical limitations (including any allergies) that might interfere with fostering?
Yes No
If yes, please explain:

Are all family members in agreement with the decision to foster?
Yes No
If no, please explain:

Dogs and small children should be supervised. Can you provide supervision at all times?
Yes No

There will be other children, ages that will visit in our home often most of the time, or at some time.

Do you know if these children have ever been around a dog before?
Yes No

If there will be any problems, please describe:

Briefly explain why you have chosen this time to bring a foster dog into the family and how all family members feel about it:

Describe your personality:

References

Please provide THREE references for us to contact. They may include a neighbor or friend who has knowledge of you with pets. Only one reference may be a relative.

Reference 1:
Name:
Address (street/city/state/zip):
Phone Number:
Email Address (if known):

Reference 2:
Name:
Address (street/city/state/zip):
Phone Number:
Email Address (if known):

Reference 3:
Name:
Address (street/city/state/zip):
Phone Number:
Email Address (if known):

I agree that all of the above information I have given is true and complete: Yes

I understand there are certain risks inherent in handling animals and I accept those risks. I understand that I will not hold PNC Midwest Rescue or its officers responsible for any and all loss, damage, injury, harm, claims, liability, costs, and/or expenses, of any nature whatsoever. I agree to this waiver of liability: Yes

Electronic Signature:

Date:

Please Note:

Filling out this application does not in any way commit you to providing foster care, transport assistance, etc. This is to help us find an area you would be comfortable in. We work very hard with our Volunteers to help them find the right fit with their time constraints, family lifestyle, work schedules, etc. If you are a first time Volunteer, we will do our very best to find the fit for you and are always available to you for assistance. We want this to be a rewarding experience for everyone involved.

If you have further inquiries, please email Heidi Eckers.

How did you find out about us?
Petfinder 1-800-Save-A-Pet Pets911 Kijiji Google Friend or Relative
Other, please explain:

You many want to print a copy of this application prior to submitting (or clearing). If you have any questions, or problems, please email Heidi Eckers.

For office use only