Cochise Canine Rescue

PO Box 87 – Pomerene AZ 85627

Jeff Robbins and Sybil Erden -- Rescue coordinators

520-212-1718 ~~~ sybil@cochisecaninerescue.org


Foster Home Application

This agreement is between Cochise Canine Rescue (hereafter referred to as CCR) and

(Your name) ___________________________________________________ (hereinafter referred to as Foster Applicant.) 

Foster Applicant is interested in caring for Dog(s) pulled from high-kill shelters by Cochise Canine Rescue until they can be Adopted.


Important Note: The Foster Homes are responsible for any Veterinary expenses and food, cleaning supplies etc which are required for the care of the animals in their care. We will reimburse the entire amount of the Adoption fees when the dog is adopted, up to the amount of receipts, but cannot and will not reimburse more than the Adoption Fee.


ALL paper work ( both intake papers, microchip and spay certificates, as well as expense receipts) MUST be sent to CCR. You will receive a TAX DEDUCTIBLE donation receipt for all you costs.

Keeping a  dog without permission or placing a dog through any non-approved means is THEFT which Cochise Canine Rescue will prosecute to the fullest extent of the Law!!!

The Applicant allows CCR or CCR’s representative to call or write the below references including Veterinarians,


Applicant gives CCR permission to contact references, employers, landlords et. al. in order to confirm the validity of the statements made below.

Name of Applicant:_____________________________________________________________________________

Address:_________________________________________City, State Zip:__________________________

Phone Numbers:_________________________________________________________________________________

Own?___ Rent?____ If renting, name & phone # of Landlord_________________________________

(If renting you will need a letter approving the keeping of Foster animals.)


I agree to a Home Check before approval as a Foster Home by CCR or one of CCR's agents. ____Yes_____No


I agree that an agent of CCR may come by to visit the animals in my care with 24 hours notice._______Yes______No

Where will the dog(s) sleep? _______________________________________________________________________


Hours the dog(s) will be alone (without human supervision) during the day:_________

Where will the dog(s) be when alone?_____________________________________________________________

I have___ do not have____ a fenced yard.

Height and construction of fencing_______________________________________________________________

I do ____ do not ____ have a swimming pool.

If yes, it has ____ does not have____ fencing appropriate to keep this dog out of the pool.



Number of people in home__________.Ages of Children:___________________

Other pets/animals in home:_________________________ Ages:___________________________


I have a separate space to keep my animals and the foster animals separated_____yes_____no


After proper quarantine period (at least 10-14 days) I plan on introducing the animals and treating the Foster as one of the family _____yes______no

If you had to move, where would your animals and the Foster animals go?_______________________________


__________________________________________________________________________________________

If you have to travel on business/vacation/or in an emergency, where will your animals go or who will care for them?____________________________________________________________________________________


Your Veterinarian: Name: __________________________________Phone #_____________________________


I will be taking the Foster animal(s) to the Vet on the way home______yes______no

Only if they seem sick______

Employer: Company and supervisor's name________________________________________________________

Phone #______________________extention:__________

How long:____years_____months 
Position:______________________________________________________


I have experience Bottle feeding and will accept orphan baby dogs ____ cats______:___________Initial




2 non-related RESCUE references i.e. people working with bone fide Rescue organizations who know you for over 1 year, or people you have worked with in Rescue for over 1 year
:

Reference #1 Name___________________________________phone #:_________________________________


Reference #2 Name___________________________________phone #:__________________________________

Personal references (friends, coworkers)


Reference #1 Name___________________________________phone #:_________________________________


Reference #2 Name___________________________________phone #:__________________________________



I understand that dogs/puppies can be destructive. I will not hold CCR liable for any damage done by animals in my care.________Initial


I understand that the dogs I will be caring from are pulled from high-kill shelters and may be frightened, nervous or skittish and am willing to work through this. I will not hold CCR liable for any injuries sustained by a person or animals due to a CCR foster dog.________Initial

I understand that if at ANY time I can no longer keep this dog, that s/he MUST be returned to CCR or a person/rescue selected by the CCR. The dog(s) MAY NOT go to a pound or shelter - if a dog ends up in a shelter, fees equaling the cost of retrieving the dog(s) will be applied! ________Initial

By my signature I affirm that the above is true and complete to the best of my knowledge and ability and that neither I nor anyone in my family have never been arrested for any form of animal cruelty, hoarding, dog fighting or cock fighting....nor have I been fired from or removed from a position working in Animal Welfare for any reason:______

 

Signature:__________________________________________________Date:___________________



   

___________________________________________________________________________________________






                                                                                                                                                   

Cochise Canine Rescue is located in Southern Arizona. We adopt throughout the state of AZ

Important Note: The Foster Homes are responsible for any and all Veterinary expenses and food, cleaning supplies etc which are required for the care of the animals in their care. We will reimburse the entire amount of the Adoption fees when the dog is adopted, up to the amount of submitted receipts, but cannot reimburse more than the Adoption Fee. We are too small an organization to do this. We WILL however send e-mails out asking for donation if the dog is injured or ill, and will reimburse as much as we can.

ALL paper work (intake papers, microchip and spay certificates, as well as expense receipts) MUST be sent to CCR.
This can be done by scanning the paperwork and emailing it to us at info@cochisecanninerescue.org, or sending by "Snail mail"  You will receive a TAX DEDUCTIBLE donation receipt for all you costs.

Keeping a CCR dog without permission or placing a dog through any non-approved means is THEFT which Cochise Canine Rescue will prosecute to the fullest extent of the Law!!!


FOSTER HOME APPLICATION


If you have ever wanted to care for a needy dog, please print out and fill in the Foster Home Application below.


Do you have experience as a Vet Tech or Bottle feeder? Please enter those special skills in the appropriate section.


Do you have special breeds you want...or simply won't take in? Let us know.