CCDR Associate Membership Application Form

Coast to Coast Dachshund Rescue, Inc.

Associate Membership Application - c2cdr.org

Thank you for your interest in joining CCDR. Please read the information below in it's entirety. We know it's long to read and the application takes time to fill out, but being a member of CCDR is a rewarding experience and we strive to assure the public that our members are caring, informed and professional when working with the public.

Note: On the application, to jump to the next question, use your tab key. Do NOT hit the enter key. If you hit the enter key you will "send" the application as if you clicked the "submit key." If you do hit the "enter key" use your "back button" on your browser to return to the form. Your information will still be there.

Coast to Coast Dachshund Rescue (CCDR) is a National nonprofit, all-volunteer organization dedicated to rescuing needy Dachshunds and Dachshund mixes. CCDR strives to find homeless Dachshunds loving forever families all over the US and Canada.

CDDR makes every effort to carefully screen all potential members and help them learn the process of successful rescue. To apply for a membership to CCDR, CCDR requires that you sign a Code of Ethics and start out as an associate member before full membership privileges are granted. An associate member will apprentice with CCDR under the guidance of their mentor for 4 months. An apprentice will have full list privileges, may do transports, shelter pulls and foster CCDR dogs and participate in fundraising events to promote CCDR. As an associate member you will be able to participate in most of the work a full member does except adoptions. Adoptions may only be done by a full member and until you are a full member, any applicant that you may have will be processed and if they express an interest in a specific dog you will work with that person who has the dog since they will oversee the adoption. If the applicant is only pre-applying, you will work with your mentor who will oversee the applicant and their application and when you, or they find a dog they may be interested in, your mentor will oversee the procedure and walk you through the process. Your mentor will answer any questions you have and will also go over rules and regulations on what is and is not expected as a CCDR member. After you have completed your 4 month apprenticeship, the membership committee will review your application for membership and if accepted, you will have the opportunity to join CCDR as a full member. You must be an associate member in good standing and have demonstrated an understanding of CCDR's policies and procedures. If approved you will be sent a letter of acceptance. At that time you will be expected to pay your annual dues of $30.00 a year and join us in Coast to Coast Dachshund Rescue with full member privileges.

The experience and passion of our members allow dachshunds to have a second chance at happiness and we count on our members to help these dogs. For the safety and well being of these dogs, it is very important that you understand and uphold the policies and procedures of CCDR.

Please do not hesitate to contact your assigned mentor or any Board Member (information on the contact page of the website as well as the representative page on the website) with any questions or concerns. Because the Dachshunds in our care are solely dependent on members for their welfare, it is necessary for associate members to work closely with their assigned mentor.

To begin the application process, an associate member must be at least 21 years of age; and have owned or have at least 1 years experience with Dachshunds. As a CCDR member it is important you know the breed characteristics, the standard, the colors and the patterns of the dogs. You can find this information in various dachshund breed books, AKC, http://www.akc.org, the Parent Club, Dachshund Club of America, http://www.dachshund-dca.org or various breed related web sites, including CCDR, http://www.c2cdr.org.

Please fill out the application below. All questions must be answered to process the application and all answers must be answered honestly. This will help your mentor to explain things to you. Please don't feel that you must be an expert. We'd rather have honest answers and help you with your experience and training.

It is important to answer all questions. Do not leave any field blank. If it is not applicable, please put n/a. Answers left blank may jeopardize your ability to become a member. Use your tab key to jump to the next question. You must be at least 21 years of age to fill out this form.

Date
Name
Street
City
State
Zip
Email Address
Home phone
Work phone:

Are you being recommended by a current CCDR member?	Yes No
If so, who is that member? Type their name

Employer
Street
City: State Zip Work phone
Do you work outside of the home?
Employer: Phone Number:
Nature of job (optional):
Employer (spouse)
Work Phone:
Nature of job (optional):

Have you ever owned a Dachshund?
How long have you owned a dachshund(s)
Are you familiar with all of the breed characteristics?
Do you know all of the colors and patterns of the dachshund for proper identification?
Dachshunds come in two AKC recognized sizes. What are they? &
There is a slang word for an oversized mini that shows up only in the pet breeding of dachshunds, list what this term is if you know it.
Do you currently own a dog(s)? Yes No
Do you currently own a cat(s)? Yes No
*If you own a dog/cat, are they altered?
Dogs: Yes No
Cats: Yes No
Are your current pets (dogs, cats, ferrets) that require vaccines UTD (up to date)? Yes No*
*If "No" please explain why.

Are your current pets that require rabies current? (one year or 3 year required vaccine) Yes No*
*If "No" please explain why

Will you be able to foster a CCDR rescue? Yes* No*

Type of residence?
Do you
*Is the landlord on the premises? Yes* No*
*Written documentation from landlord or proof of pet deposit required prior to fostering.
Landlord's Name
Street City:
State Zip:
Work phone
Do you have a yard? Yes No
Approximate size
Completely fenced? Yes* No
*If yes, type/height?
If no, are you willing to fence, install a pen or run, or leash walk at all times? Yes* No*
*Please specify

In cases of inclement weather, is there shelter outside for the Dachshund? Yes No
Are there stairs in your residence? Yes No
Are you planning to move in the next 6 months? Yes No
Would your pets accept a new dog? Yes No Not Sure
Do you often have other people visiting your home? Yes No
Grandchildren? Yes No Other children? Yes No
Where will the dog be kept during the day?
At night?
When left alone?
How many hours a day will the dog be at home alone?
Where will the dog sleep?
Where and how will the dog exercised?
Have you ever housebroken a dog before? Yes* No
*What method did you use?

Would you accept a dog that is:
Older? Yes No
Recovering from medical treatment? Yes No
Proven unreliable with children? Yes No
Previously abused? Yes No
Physical handicap? Yes No
Pregnant and will be whelping? Yes No
Have you ever whelped a litter? Yes No

Do you currently own any other pets? Yes* No
*If yes, continue. If no, please proceed to (3)

Please list species, breed, sex, whether the pet is neutered or spayed, note if the pet is kept inside or outside and how long you have owned this pet. (the neuter and spay question refers only to cats and dogs)

Please type your answers in the boxes and check the appropriate box whether your dog is altered or not.

Species Breed Sex Is your pet altered? (spayed or neutered) Yes this pet is altered No, my pet is not altered yet Age Kept In/Out Owned How Long

If you have other dogs or cats please add the same information that is above in this text box. Please tell us about all of your dogs and cats.

(Altering (spay or neuter) is in reference to a cat or a dog only)
Are your pets current on Heartworm preventative? Yes* No Not Sure
*What kind?

How often are they tested for Heartworms?

How would your characterize your pets? (dominant, submissive, playful, etc.)

If you have previously owned pets, what happened to those no longer living with you?

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

Dachshunds can be very prey oriented. Do you have small pets (rodents, birds, etc.) Yes No
We wouldn't want anything to happen to a small pet and since a foster dog coming into your home may or may not have a high prey drive, are you willing to put your small pets in a very safe place until you get to know the behavior of the foster dog? Yes No
CCDR cannot be responsible should a foster dog injure a small pet. Please understand you are taking full responsibility to protect your small pets and undersand CCDR is not liable if something happens to them. Dachshunds have a high prey drive and you must be very diligent in protecting those pets who may be at risk. Do you agree to this requirement? Yes No

Please list the name, age, and relationship of those residing with you.
Name Relationship Age
Name RelationshipAge
Name Relationship Age
Name Relationship Age
Name Relationship Age

Dog Experience
Please describe any experience you have in training (do you do AKC events, obedience, agility, other dachshund sports.)

Do you have experience with rehbilitating dogs that have emotional issues? (abuse, puppy mill dog, lack of socialization)Yes No
Do you have any experience with physical rehabilitation (a dog who has had back surgery, broken bones, surgery, etc.) Yes No
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

Other Organization Affiliations
Have you been a member or helped any other type of rescue organization (other than dachshund)? Yes No
What breed and what is the name of the organization.
Are you still a member of another rescue group? Yes No
Have you been a member of any dachshund rescue organization? Yes No
(CCDR does not allow dual memberships (where you are a current member of another dachshund rescue group) between CCDR and other dachshund rescue organizations but you may belong to other rescue groups that are not specific to dachshunds)
If you are or have been with another dachshund rescue organization(s), what is the name of the organization(s) Please list most current and all of those you've been a member of or volunteered with, how long you were a member and why you left.

Please list the president or a board member's name and email where we can contact them for a reference.

If you prefer we not contact the president or board member, please explain why and provide a reference (another member) as a reference. We understand there can be sensitive reasons why you left or wish us not to contact an officer. Please explain in full though. Your answer will be kept private.

Please list any other animal welfare affiliations, months/years of membership, and general responsibilities*.
*General responsibility may represent financial endorsement and does not have to be a titled position within the organization.
Name of Organization(s)
Months/Years
General Responsibility
If you are involved with other pure breed or all breed rescues organizations will you agree to process all rescued dachshunds solely through CCDR, based on our policies and procedures? Yes No*
*If no, please explain (you must explain in full why you would not process a dog through CCDR).

Shelters
Have you ever rescued a dog from a shelter? Yes No
Are you willing to pull a dog from a shelter? Yes No
Do you feel it is important to maintain a working relationship with a shelter? Yes* No*
*Please explain your reason whether "yes" or "no".

Do you currently have a contact at your shelter? Yes No
Are you aware that many shelters cannot accurately estimate the day of euthanasia? Yes No

Owner Surrenders
Have you ever rescued a dog surrendered by the owner? Yes No
Owner surrenders can be emotional. Are you willing to empathize with an owner prior to the dog's surrender and keep it professional? Yes* No*
Do you understand the importance of an owner signed surrender form? (CCDR has these forms available within the organization) Yes No

Placement Screening Process
Have you ever placed a rescued dog? Yes* No
*If yes, did you place the rescue as: A member of a rescue organization. Which one?
Independently Both
Was the dog altered before placing them in their adoptive home? Yes No
Have you ever screened a potential applicant? Yes** No
**If yes, continue. If no, please proceed to (10.)
Which of the following did you use in the screening process? Application Home CheckReference Check Veterinary Reference
Was the dog spayed/neutered prior to placement?Yes No
*Did you contractually require proof of spay/neuter at an agreed upon date? Yes No
Was the dog up to date on shots prior to placement? Yes No
Did you use an adoption contract with your placements? Yes No

Transports
Would you be willing to assist in transporting Dachshunds? Yes* No
*What length of time are you willing to drive?

Public Relations
Are you willing to correspond with the general public in a professional and educational manner?Yes* No
Not Sure
*Even when their beliefs are contrary to the mission of rescue? Yes** No
Are you able to respond to an interested party within a 2 day time span? Yes No

Skills
Do you have any special skills (managerial, coordinator, accounting, etc) that might be helpful in assisting CCDR in its mission? Yes* No
*If so, please elaborate

*Veterinarian: YOU MUST fill this information out even if you do not currently have a dog. If you've never had a dog and never established a veterinarian , put n/a.

Veterinarian's name, Clinic Name, Address, Phone number and email address

*References: YOU MUST FIll out all 3 references.

*Reference 1

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

*Reference 2 (Not related to you)

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

*Reference 3 (Not related to you)

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

*Hold Harmless-Required Reading

By inserting a check mark next to the following statements, you agree to all conditions set forth by Coast to Coast Dachshund Rescue.
I understand that Coast to Coast Dachshund Rescue is a private, non-profit, all-volunteer organization devoted to rescuing and placing dachshund and dachshund mixes in need.
Because of my intention to aid CCDR in its charitable pursuits, I agree to hold CCDR, and/or representatives thereof, free and harmless from any loss, damages, injury or death to any person, animal or property caused by the CCDR dachshund(s) placed in my custody. I understand dogs coming into rescue may demonstrate behavior that may cause conflict temporarily in a home with existing animals, therefore, I will exercise great care and take full responsibility to ensure that any animal (CCDR dog, my own private animals, children, adults) are taken into consideration and will never put anyone or anything at risk. I will secure a rescue dog safely in all new or existing circumstances until I am sure how the rescue dog will respond in the new environment. I will not assume a dog will bite under stressful circumstances and will take precautions until I am confident of the dog's comfort level in it's temporary home.
I am aware that the CCDR dog(s) may have undetectable illnesses. Further I realize that CCDR is responsible only for the medical care of the CCDR dog(s) and that I, alone, am responsible for any acts for the CCDR dog(s), once placed in my custody and under my care.
I understand that the veterinarian, CCDR, or representatives thereof, are taking no responsibility as to the character or disposition of the CCDR dog(s).
I will contact my CCDR mentor immediately should the foster dog become lost, stolen, seriously ill or die and/or bite in an aggressive manner. "Contact" shall mean verbal communication between your CCDR mentor, and/or a board member thereof, either by telephone or in person.
The foster dog will wear a CCDR ID or a regular ID tag at all times.
I understand that there is a 4 month probationary period for all associate members. If at the end of that probationary period the associate member is in good standing and has demonstrated a full understanding of CCDR policies and procedures, they will be offered a full membership opportunity. At this time they associate member will be expected to pay the full membership dues of $30.00 a year.
Upon receipt and review and prior to official membership, I agree to follow the CCDR policies and procedures and uphold the Members' Code of Ethics.
Are you working with a CCDR member? Yes* No *If so, please provide name
Please list who you know in CCDR or who you have been working with. Select the one you'd like to have as your mentor.
Name: Member's email:
Name: Member's email:
Name: Member's email:
Name: Member's email:
I understand that I must complete an associate membership of 4 months under the supervision of a mentor who is a full CCDR member before being invited to join CCDR as a full member with full member privileges. At the time of acceptance (after the 4 month training period) I understand I must pay my yearly dues of $30.00 before receiving CCDR member material or becoming a full member. I understand this a valuable training period and will be able to perform all membership functions except the actual adoption of a CCDR dog. 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 for CCDR. Any misrepresentation of the true facts in this Member application will invalidate my CCDR associate membership and privileges and will give CCDR the right to immediately reclaim any and all CCDR foster dogs in my care.

*The information provided in this application (in its entirety) is true. I give permission to have all information verified, am at least 21 years of age and agree that submission of this form will constitute a legally signed document stating all facts are true and current.
(enter your name here to "sign")

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