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?

If you currently have a dog or dogs, what is the extent of their obedience training? If you have never had Basic Dog Obedience Training for a large breed dog, SSRR will assist you in finding an approved course.

Why have you chosen Rottweiler Rescue?

Foster Information

Can you foster a dog until a permanent home can be found or other arrangements made?

If not, please estimate a maximum time frame:

If you are willing to provide a foster home for a Rottweiler, we need the following info.

Number of Children:

Their ages:

How long have you lived at this address?

Please indicate which best describes your current living situation:

Type of environment:

Do you:

If you rent, please provide the following:

Landlord's Name:

Landlord's Phone Number:

How long have you lived at this address?

If < 2 years, previous address and landlord:

Does anyone else live in your home?

Person #1 Name/Relationship/Age:

Person #2 Name/Relationship/Age:

Person #3 Name/Relationship/Age:

Do you have a fenced yard?

Type and height of fence:

Is the fence secured underground?

Is the gate padlocked?

Do you have a homeowners or renters insurance policy?

Name of insurance company:

What is the maximum number of dogs/pets allowed by city ordinance?

Do you own a Dog Crate?

If so, what type and size is the crate?

If you do not own a crate are you willing to buy one and crate train the rescue?

If no, please explain why?

Is someone home during the day?

If not, where will the dog stay while you are gone?

Where will the dog be kept most of the time?

If kept outside, will you have a: (Dogs are not to be chained or tied out and left at any time)

Have you fostered any animal in the past?

What kind of animal?

Through which agency (name, phone number)

What are you willing to provide for a foster Rottweiler (food, shelter, training, activities)?

Would a male or female Rottweiler fit better in your home?

Age range?

Other criteria for dog you'd be willing to foster:

Are you willing to provide transportation to and from the vet, adoption sites, etc. as needed?

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 currently have a dog or dogs, what is the extent of their obedience training?

If you have never had Basic Dog Obedience Training for a large breed dog, SSRR will assist you in finding an approved course. It is mandatory that within 30 days of adoption that a Structured Basic Dog Obedience Course be scheduled. The class must be completed within the first 90 days of the adoption. All dogs under the age of 1 year old are required to take Basic Obedience Training. Certificate of Completion of "Obedience Class" will need to be sent to SSRR.

Veterinarian Name:

Veterinarian Phone:

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:

Have you ever had a pet hit by a car?

Please list all the animals you have owned in the past 10 years and what happened to them:

What do you enjoy most about dog ownership?

What do you like least about dog ownership?

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

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.

Other 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

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

Thank you for applying to become a much-valued Southern States Rescued Rottweilers, Inc. foster volunteer!

I provide my own automobile and health insurance, and hereby agree to not hold Southern States Rescued Rottweilers, 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 Rescued Rottweilers, Inc. This includes any and all activities I perform as a Southern States Rescued Rottweilers, Inc. foster 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."

It is required that you fill out this application online. We will also will require a hard copy of your signature prior to placing an animal with you certifying the above information. You may print the form out after you have submitted it online and mail or fax it, with your signature to:

Southern States Rescued Rottweilers, Inc.

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

Signature (re-type email address):