Volunteer and Foster Home Application

Section 1 - Volunteer Information

Your Name:
Street Address:
City:
State:	Pick State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington District of Columbia West Virginia Wisconsin Wyoming Test Only   Zip:
Home Phone Number:
Work Phone Number:
Fax Number:
Email Address:
When is the best time to call?

Vet Information

Do you have a regular veterinarian?	Yes  No
Vet Clinic Name:
Doctor Name:
Street Address:
City:
State:	Zip:
Vet Phone Number:

Section 2 - Home Environment

Do you own cats?	Yes  No
How many dogs live with you?
Breed/gender/age of each dog:
Do you breed?	Yes  No
If Yes, how many litters per year?
Are your pet’s spayed/neutered?	Yes  No
Are there children that the dog will come in contact with?	Yes  No
If yes, how often will the dog be exposed to them?
Age/Gender of each child:
Please check the area(s) listed below in which you would be interested in volunteering:
Screen Applicants/Adoption Counseling   Transport dogs   Behavior Counseling   Foster Home (please complete sections 8 and 9)   Fund Raising   Home Visits   Staff booths/information centers (table at trials, pet expos, etc.)   Shelter Contact   Maintain local lists of dogs available/post to national list (internet access needed)   Other (please describe):

Section 3 - Experience

Please describe previous volunteer and rescue experience:

Do you have any special dog handling experience? Please describe.

Section 4 - Schedule

How many hours per week can you devote to Russell Rescue? PLEASE BE REALISTIC!
How flexible is your schedule? For example, if you receive a call in the morning, can you make time during the day to pick up a dog in an emergency situation?
Please let us know your availability. Can you be reached at work without it causing a problem, etc?

Section 5 - Opinions / Preferences

Please describe your feelings about what rescue is:

How would you feel if you had to recommend euthanasia of a Jack Russell Terrier?

Under what circumstances could you see yourself recommending euthanasia?

Are you willing to handle and/or evaluate (check all that apply)?*

Sick dogs   Pregnant females   Dogs deemed mentally unstable by owner   Females in heat   Dog-aggressive dogs   Intact dogs (until spay or neuter can be arranged)   Dogs that don’t like children   Geriatric dogs   Dogs that are not housebroken or crate trained   Extremely hyper dogs   Escape artists * Please note: It is the policy of the Russell Rescue, Inc. not to take biting dogs.

Please list anything else you are or are not willing/able to work with:

Section 6 - Reference / Comments

Reference: Other JRT owner or someone familiar with your philosophy on pet ownership:

Please provide any additional comments:

Section 7 - Volunteer Waiver

I fully understand and agree to assume all risks involved in any and all duties that I perform for Russell Rescue, Inc. in my volunteer capacity and I agree to hold Russell Rescue, Inc. harmless for any injury(s) 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 Russell Rescue, Inc. or its representatives.

Please indicate your agreement with the statement above:

I Agree

Section 8 - Foster Home Application

Please SKIP sections 8 and 9 if you are not applying as a foster home.
Please check all that apply: Crate   Fenced yard   Kennel
Describe fence and/or kennel run: (type, height, size)
Do you own or rent your home? Own  Rent
I live in a: ** Select ** House Apartment Trailer Other  If "Other":
How long have you lived at this address?   (Years/Months)
Where will foster dog be housed during the day (check all that apply)?
Inside crated   Outdoors loose (in fenced area only)   Inside loose – list location     Outdoors kenneled   Garage   Barn   Other
Where will foster dog be kept when unsupervised or when left alone?
Inside crated   Outdoors loose (in fenced area only)   Inside loose – list location     Outdoors kenneled   Garage   Barn   Other
Where will dog sleep?
Inside crated   Outdoors loose (in fenced area only)   Inside loose – list location     Outdoors kenneled   Garage   Barn   Other
Are you aware that most foster dogs have unknown medical and behavior history?	Yes  No
Are you willing to accept all responsibility and liability of a foster dog’s actions on or off your property while in your care?	Yes  No
Are you willing to travel to pick up a foster dog?	Yes  No
Distance you are willing to go (round trip):
Are you willing to travel and/or open your home for potential adopters to visit the dog?	Yes  No
Are you aware that a foster dog may be in your home for an indefinite period of time?	Yes  No
At times a foster dog may need veterinary attention. Are you willing to transport the dog to the vet?	Yes  No

Section 9 - Foster Home Application Waiver

Please SKIP sections 8 and 9 if you are not applying as a foster home.
Information you should know: Dogs in foster care are to be placed only by an authorized Russell Rescue, Inc. 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 for the caregiver. Russell Rescue, Inc will provide food and necessary medical expenses for all foster dogs. A designated Russell Rescue, Inc. Representative MUST authorize all vet expenses. I am aware that by signing this application, I agree to provide what is needed for the health and safety of a dog fostered in my care for the Russell Rescue, Inc. 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 the Russell Rescue, Inc. I fully understand and agree to assume all risks involved in any and all duties that I perform for Russell Rescue, Inc. in my volunteer capacity and I agree to hold Russell Rescue, Inc. harmless for any injury(s) 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 Russell Rescue, Inc. or its representatives.
Please indicate your agreement with the foster home waiver above:	I Agree

Please review your answers carefully before submitting
this application to Russell Rescue, Inc.