Coast to Coast Dachshund Rescue, Inc.

Foster Home Application
For new applicants, all fields on this form must be filled out completely. Thank you.
*I am a new foster home applicant
*I am/This is an existing foster home updating  information (the foster home can fill this out or the member can fill this out with the updated information)
Section 1
Date:*
Name:*
E-mail address*
Telephone:*
Street:*
City:*
State:*
Zip:*
Work Telephone: (if applicable)*
I have been working with:*
(member's name)
The email address of the member I am working with:*
Section 2


Please list pets you now have in your home:

Do you currently have pets? 
Yes No 

If yes, please fill out the following information

How many dogs do you have in the home? How many cats do you have in your home?
Type/Breed Gender Spay/Neut. Age Owned Since:
Male Female
Spay Neut.
Male Female
Spay Neut.
Male Female
Spay Neut.
Male Female
Spay Neut.

Have you bred any of your current or past dogs/cats to have puppies/kittens? Yes No 

How many adults in your household? 

Children? 

Ages of children: 

Please list the name, age, and relationship of those persons residing with you.
Name Relationship Age 
Name RelationshipAge 
Name Relationship Age 
Name Relationship Age 
Name Relationship Age 
If there are others, please list them here:

Do you have much contact with grandchildren, neighborhood or other children coming to your home? 
Yes No



Are you currently a member of a rescue organization?  Yes No
Please list the group(s).

Please list any organizations you've been involved with in rescue or breed.

Please list groups you currently foster for or have fostered for:

What is the name of your contact person if you foster for another group.

What breed(s) of dog do you foster. Please list all dogs.

How many other dogs, besides your own, do you have in your home?
Comments (please note anything you feel CCDR should know if there are any conditions regarding your ability to foster for us.)


*CCDR Policy is that we will not adopt to or allow a foster home to have unaltered animals. The only exception is a dog in the home that is a currently being shown for it's championship or if the dog cannot be altered due to medical problems (veterinarian verification required). 

Would your pets accept a new dog into the household? 
Yes No

Are all of your pets up-to-date on its vaccinations, rabies and heartworm prevention? CCDR will not put a dog in a home that does not have all pets up to date or in a home with fleas or ticks. 
Yes No 

Foster homes must have a home visit. Are you receptive to this?
Yes No 


Veterinarian: (Reqired)
Veterinarian's Name, Clinic Name, address, Phone number, Email address if available

References: (Required)

Reference 1

Name:
Street Address:
City:
State:
Zip:
Phone Number:
Email Address:
Relationship to you:


Refernce 2 (Non Relative Reference)
Name:
Street Address:
City
State
Zip
Phone Number
Email Address
Relationship to you


Reference 3 (Non Relative Reference)
Name:
Street Address:
City
State
Zip
Phone Number
Email Address
Relationship to you



Do you: 
Own or rent
HouseApartment Condo 

If renting, please give landlord's name, address, and telephone number. We require the landlord's written consent for your having a dog. Please mail this consent to us. Application cannot be processed without written consent. 

Landlord's Name: 

Street: 

City: 

State: 

Zip: 

Tel.: 

CCDR has a total restraint policy. Do you have a securely fenced yard? 
Yes No 

How high? 

If not, are you willing to fence, install a pen or run, or leash walk at all times? 
Yes No

Please specify



What are the working hours of the adults in the house or list the maximum number of hours the dog would be left alone? 

Does anyone in the house have allergies? 
Yes No

Please describe the activity level of the house - busy in and out a lot, or is it a more quiet, structured atmosphere? 

Where will the dog be kept during the day? 

Where will it sleep at night? 

Where will it be kept when left alone? 

Where and how will the dog be exercised? 

How many hours per day will the dog be left alone? 


Dachshunds vary greatly in temperment, personality, and activity level. What characteristics would you find undesirable in a foster dachshund? Please be extremely honest in what you cannot or will not accept in a foster dog. Dogs coming into foster care often have a number of issues that need work, housetraining, behavior, separation anxiety, etc. If you feel you cannot handle anything specific, please be honest and tell us. We don't want to ask you to foster a dog for us if you cannot handle certain situations. If you have other pets and you cannot foster a young, rambunctious dog because of a senior pet or a child, that is important to know also. CCDR will try to find a foster dog that can fit easily into a foster home but we have to know what a foster home can handle.We don't want a foster to have to be put into another home until they are adopted, so, please be honest on what you can and cannot accept in a dog.

Would you accept a dog that is older? Yes No 
has been abused? Yes No 
is not reliable with children? Yes No
has a physical handicap? Yes No 
is pregnant and will be whelping? Yes No 
is recovering from medical treatment and may need foster care for 2 to 4 months? 
Yes No 

Please describe any experience you may have had in training and/or rehabilitation work with dogs. 

Some rescue dachshunds have problems with separation anxiety, fearfulness or dominant behavior. Would you be willing to help retrain a dog following a specific behavioral remediation program that included support from a trained professional? Yes No

If necessary, would you be willing to take a foster dog to obedience training (at CCDR's expense) or to obedience train him yourself? Yes No
 
 
 


  • As a foster home I understand that while in foster care of a CCDR dog I will provide shelter, food and security and that only those medical procedures that are approved by CCDR will be paid for by them.  Anyhing else, such as heartworm medication, flea treatment, grooming, nail clipping,  training or boarding will be absorbed by me unless prior contact with a Board member for approval of reimbursement has been done and only for legitimate reasons. As a foster parent I understand that I am helping rescue by fostering and personally covering the expenses of normal care. 
  • While in foster care, I will not mistreat or abuse a CCDR foster. I understand that if I do or CCDR finds I have been negligent, I will have the foster dog removed immediately and will no longer be able to foster for CCDR. I understand that if a foster dog has an accident that is due to my lack of care or my pet injures the foster, I am responsible for the medical bills for the CCDR foster. I understand I have a requirement to meet or exceed proper care while a CCDR foster is in my home.
  • I am aware that CCDR dogs may have undetectable illnesses and as a foster home I will take all precautions to quarantine a new dog coming in to my home. CCDR is responsible only for the medical care of CCDR dogs and will treat the foster medically. I understand that only a CCDR dog's medical care will be paid for and should my pet need medical care by contracting something a CCDR dog has, I am responsible for my own pet's medical bills. I also realize that CCDR is not aware of the temperament or history of the dog in many cases and therefore realize that I am responsible for taking extreme care and precautions when bringing in a foster dog. Therefore, I understand that any medical issue or injury that occurs as a result of my negligence will be covered by me. I am fully responsible for the well being of the foster dog until it is officially adopted.
  • I will contact a CCDR representative immediately should the fostered CCDR dog become lost, stolen, seriously ill or die.  Contact means verbal communication between a CCDR board member (all contact information is on the contact list of the website; http://www.c2cdr.org), and/or a representative that I am working with either by telephone or in person.
  • The fostered CCDR dog will wear an ID and rabies tag at all times. (Foster homes can create a temporary tag or if a CCDR tag is available, it will be supplied) 
  • I understand that should I decide to permanently adopt a CCDR foster dog in my care, I will pay CCDR the full adoption fee that has been determined for this dog immediately. I understand that I have a week to make this decision once the dog enters my home, otherwise I am fully aware that at any time an adopter may adopt the foster dog I am in charge of. I will notify the representative or a Board member that I wish to adopt the foster dog in my care and I agree to pay this fee and return a signed adoption contract immediately. 
By clicking "I Agree" below, I agree to the above statements and release and covenant to hold harmless CCDR, Inc. and its members from any claims, damages, costs, or actions incurred as a result of the foster care or actions of the foster dog. I will notify CCDR immediately should the foster dog become lost, stolen, seriously ill or die. The foster dog will wear a CCDR ID tag at all times. I understand that should I decide within the first 7 days of foster care to permanently adopt the CCDR foster dog in my care, I will pay CCDR the full adoption fee to help defray the costs of spaying, neutering, shots, heartworm test and other medical expenses that have been incurred by CCDR. The adoption fees are currently on the website. 

I certify that I am at least 21 years of age and that I will be solely responsible for the care and well-being of any dog that I foster care for CCDR. Any misrepresentation of the true facts in this foster home application will invalidate the foster home agreement and will give CCDR the right to immediately reclaim the foster dog. 

My signature

Date: