Rescue Volunteer and/or Foster Care Provider Form

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

Although this dog has received excellent care while here,
it is the nature of rescue work that not everything about
the history or status of the animal can be known.

I recognize that handling this previously stray/rescue
animal(s) may place me and/or others with me at risk
for being scratched or bitten.

I understand the risks inherent in handling any previously
stray/rescue.

I agree to indemnify and hold harmless the Coastal Jack
Russell Rescue, its officers, directors, employees, agents,
and representatives from all manner of actions and causes
of actions, suits, debts, dues, accounts, bonds, covenants,
contracts, agreements, judgments, claims and demands
whatsoever arising out of my possession and placement
of this animal.

I am aware that by signing this application, I agree to
provide what is needed for the health and safety of the
dog fostered in my care for the Coastal Jack Russell
Terrier Rescue.

I further agree to assume all responsibility for the foster
dog in my care while on or off the premises. I agree to
assume all liability for the dog while I foster it for Coastal
Jack Russell Terrier Rescue.

I fully understand and agree to assume all risks involved
in any and all duties that I perform for Costal Jack
Russell Terrier Rescue in my volunteer capacity and I
agree to hold Coastal Jack Russell Terrier Rescue
harmless for any injuries that I might sustain during the
course of my volunteer duties.

This waiver does include myself, all of my family
members and descendants forever from seeking any
legal action whatsoever against Coastal Jack Russell
Terrier Rescue or its representatives.

I, the undersigned, attest that, to the best of my
knowledge the 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.

INFORMATION YOU SHOULD KNOW:

* Dogs in foster care are to be placed only by an authorized
Rescue representative. You will not be allowed or expected
to place the dog on your own.

* Foster homes are responsible for the costs of any medical
attention that result from an injury due to negligence from
the caregiver.

* Coastal Jack Russell Terrier Rescue will provide food and
necessary medical expenses for all foster dogs. A designated
Rescue Representative MUST authorize all vet expenses.

If you would prefer to work with a printable version of our rescue volunteer
form, please choose the appropriate link below:

rescue volunteer form (pdf format requiring Adobe Reader)
rescue volunteer form (doc format requiring Microsoft Word)

To complete our volunteer application online,
please fill out and submit the form below.
By completing and submitting the application below,
you agree to all terms and conditions listed above.

Do you agree to all terms and conditions listed above?
Yes
No

First Name:

Last Name:

Address:

City:

State:

Zip Code:

Email Address:

Home Phone:

Work Phone:

Cell Phone:

How many adults in the household?

Please describe the age and gender
of any children in the household:

Indicate which best describes your type of dwelling:
Apartment
Apartment style condominium
Townhouse duplex or triplex
Mobile Home / Manufactured housing
House
Farm
Other

If your answer above was 'Other', then please describe:

How long have you lived at this address?

Do you own or rent this dwelling?
Own
Rent

If you rent, do you have the
landlord's permission to keep a dog?
Yes
No

Which 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

What is the size of your yard?

Is your yard securely fenced?
Yes
No

If you answered "Yes" above then what type of fence and how tall?

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

Do you have a secure dog run?
Yes
No

Where would the dog(s) sleep?

Would your plans include using a crate?
Yes
No

Why?

Your plan would be to keep the rescue primarily:
Indoors
Outdoors

Please explain:

Do you have adequate shelter, such as a doghouse, or kennel area where the dog can take refuge from the elements?
Yes
No

If not, do you plan to get such shelter before accepting your first rescue?
Yes
No

Do you currently own, or, have you ever owned a Jack Russell Terrier?
Yes
No

If you answered "Yes", then how long have you had, or how long did you have it?

If you answered "Yes", then where did you get it?

Do you have any other pets at this time?
Yes
No

If you answered "Yes", then please describe what kinds of pets you have, as well as their gender?

If you answered "Yes" above, then are all vaccinations current for all of your pets?
Yes
No

Have all of your pets been spayed or neutered?
Yes
No

If you don't have a pet now, have you owned one in the past?
Yes
No

If you already own a dog(s), how would you consider it(them) toward other dogs:
Aggressive
Submissive

How do you think your other pets would react to a rescue dog... and are you prepared to deal with reactions on the part of your other pets?

Are you willing to foster a Jack Russell terrier for a short period of time?
Yes
No

Why are you considering becoming a foster home for a Jack Russell terrier?

What area would you be willing to cover with regard to Rescue?
(check all that apply)

City - Which city?

County - Which county?

Neighboring counties - Which counties?

Regionally - For example: Coastal, Midlands, or Upstate.

Statewide - Which state?

Anywhere rescue is needed

Other

What types of Jack Russell Terriers would you be willing to foster? (e.g. only males, only females, only older dogs)

Would you be willing to take a terrier that did not fit this criteria in an emergency situation?
Yes
No

Are you prepared to provide the extensive socialization that is needed to ensure that you have a well rounded Jack Russell terrier for placement?
Yes
No

Please indicate any area that you will not be able to expose a foster terrier 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
Being alone in a house
Being alone in a car
Nail clipping

What medical considerations would you make in fostering a rescue terrier? (e.g. wouldn't take a rescue that's been diagnosed with heart worms)

Are you agreeable to spaying/neutering every terrier that you foster?
Yes
No
Why?

How many terriers are you willing to foster at once?
One
Two
Three
More than three

Are you likely to do any dog training with the foster dog while in rescue?
Yes
No

If so, what type, and how much?

What is your definition of disciplining a dog?

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

Would you be able to cope with the situation in which a dog that comes into rescue becomes sick and should be euthanized in order to stop its suffering?
Yes
No

Are you agreeable to having dogs euthanized because of temperament problems?
Yes
No

Why?

If you indicated "No" above, then what would be your alternative solution?

Are you willing to foster Jack Russell terrier mixes?
Yes
No

How would you handle a situation in which a rescue terrier bit you?

How would you handle a situation in which a rescue terrier bit someone else?

Would you be willing to deny an adoptive family a particular terrier because the placement didn't "feel" right?
Yes
No

Would you be willing to allow us to visit your home?
Yes
No

Do you have the support of your family regarding your desire to involve yourself in rescue?
Yes
No

Are you willing to work closely with our rescue organization in making a placement for the rescue terrier?
Yes
No

Have you emotionally prepared yourself for the sadness that comes when you finally make a placement?
Yes
No

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?
Yes
No

Are you willing to provide counseling/resources to the adoptive family should problems arise later on in the placement?
Yes
No

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

How did you find out about Coastal Jack Russell Terrier Rescue?

Please give us your comments or suggestions:

Please list three references that can attest to your suitability as a pet owner, and more specifically, a foster parent for Coastal Jack Russell Terrier Rescue. If you currently own any pets, you may include your veterinarian as a reference.

Reference #1

Name:

Address:

City:

State:

Zip Code:

Day phone number:

Evening phone number:

Reference #2

Name:

Address:

City:

State:

Zip Code:

Day phone number:

Evening phone number:

Reference #3

Name:

Address:

City:

State:

Zip Code:

Day phone number:

Evening phone number:

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 so, 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 click the Submit button below when you have completed this form.

Coastal Jack Russell Terrier Rescue
For more information email: JumpinJackRescue@gmail.com