Personal info:

Name:

Age:

Address:

City/State/Zip:

Email Address:

Home Phone:

Work Phone:

Cell Phone:

Your Employer:

May we call you at work?

May we call for a reference?

Spouse/Significant Other Name:

Spouse/Significant Other Age:

Do you do rescue on your own?

If so please explain.

Do you work with another Rottweiler Rescue?

If so please explain and give the Name, Address, Phone # & E-Mail Address of the other rescue.

What experience or special training would qualify you as a Southern States Rescued Rottweilers, Inc. foster volunteer?

Why have you chosen Rottweiler Rescue?

Volunteer activities

Would you volunteer to help with any of the activities listed below?

Help Transport?

Transportation - specify locale, type vehicle, distance.

Home Checks?

Home Checks/Follow up visits - specify area

Fund Raising - Raffles, Bumper Stickers etc.

Returning Phone Calls?

Checking References?

Special Projects - Grants, Acquisitions etc.

Staffing Educational Booths?

Evaluating/Photographing Dogs for Adoption?

Veterinary Services?

Tattooing Services

Training?

What type of training?

Other Help

Pet information

Do you currently have other pets?

If yes, please describe each pet in detail (species, age, breed, sex, spayed/neutered, personality):

If you have owned other dogs and do not now, what happened to them?

Veterinarian Name:

Veterinarian Phone:

Approximate date of your current pet's last office visit

List any Humane Societies, Kennel Clubs, Breed or Training Clubs you are associated with:

Names of animals seen at that vet clinic:

Are your pets current on vaccinations?

Are your dogs on heartworm preventive medication?

Brand If no, why not?

If you have pets that are not spayed or neutered, please explain why:

We will attempt to provide you with an honest evaluation of temperament on any dog we have to place.

Do you realize that often times the complete history of a Rottweiler may not be known and you may encounter some behavioral problems?

Are you willing to work with us on correcting these problems?

The following must be filled out even if you are not applying to Foster. Please provide the name, address, phone number and or e-mail address (please note if this is a home or work number) of three references. References must be someone other than family members:

Reference #1 Name/Phone Number:

Reference #2 Name/Phone Number:

Reference #3 Name/Phone Number:

By submitting this form I give SSRR permission to contact my personal and vet references.

How did you hear about Southern States Rescued Rottweilers, Inc.?

Additional comments

Thank you for applying to become a much-valued Southern States Rottweiler Rescue, Inc. volunteer!

I provide my own automobile and health insurance, and hereby agree to not hold Southern States Rottweiler Rescue, Inc. or any of its volunteers, associates or foster care providers liable for any physical, emotional or property damages that are a direct or indirect result of activities involved in the placement, transport, grooming, training or evaluating of Rottweilers in any way associated with Southern States Rottweiler Rescue, Inc. This includes any and all activities I perform as a Southern States Rottweiler Rescue, Inc. volunteer.

"I/we hereby state that neither I/we nor anyone in my/our household, nor anyone who will have access to or care for this dog, has ever been charged with or convicted of any offense involving animal neglect, abuse, or cruelty, regardless of any dismissal or deferred prosecution or other expunging of the records. I/we understand and agree that if this statement is found to be incorrect, without further evidence of any other contract violation, the Rescue may immediately obtain return of all animals adopted to me/us, without refund of any sums paid, donated, or expenses incurred. Further, it is agreed that I/we shall pay all costs of the recovery and return of said dog(s) incurred by said Rescue."

Southern States Rescued Rottweilers, Inc.

Attn: Sue Campbell,
3894 Roscommon Drive,
Clarksville, TN 37040

Signature (re-type email address):