Cheryl Egerton President of the Basenji Club Of Canada
BASENJI CLUB OF CANADA
RESCUE PROGRAM
APPLICATION TO FOSTER
Amy National Rescue Program Co-ordinator


* ABOUT YOU *

Name _______________________________________________________________ Age _____________________

Spouse _____________________________________________________________ Age _____________________ 

Address ______________________________________________________________________________________ 

City _____________________________ Province/State _________________ Postal/ZIP Code __________

Home Phone # _________________________ Will you accept a collect call from us? Yes [ ]  No [ ] 

Cell Phone # _________________________________________________________________________________

Email address(es) ____________________________________________________________________________

When is the best time to contact you? ________________________________________________________

May we contact you at work?   Yes [ ]     No [ ]
If yes, when is a good time to call? _________________________________________________________

Please indicate which best describes your current living situation:
House [ ]   Condo [ ]   Townhouse [ ]   Apartment [ ]   Mobile Home [ ]   Other ______________
Do you Rent? [ ]   Own? [ ]   Live with parents? [ ]

If you rent, do you have your landlord's permission to foster a dog? Yes [ ]    No [ ]

Name & phone number of landlord ______________________________________________________________  

______________________________________________________________________________________________

What type of environment? City [ ]   Suburban [ ]   Country [ ]

How long have you lived at your current address? _____________________________________________

If less than two years, please list your previous address ____________________________________ 

Your employer _____________________________________________________ Phone ____________________

Job title ____________________________________________________ How long employed there _______

Spouse's employer _________________________________________________ Phone ____________________

Job title ______________________________________________________How long employed there ______

Number of children _______ Their name(s), gender(s) and age(s)________________________________ 

______________________________________________________________________________________________

Besides your immediate family, are there others residing in your home? 
Names:                                           Ages: 
______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

Is everyone in your household in agreement on fostering a rescue dog?
Yes [ ]    No [ ]
If no, who is not and why?____________________________________________________________________

______________________________________________________________________________________________

Does anybody in your home have allergies? Yes [ ]    No [ ]
If yes, what are they allergic to?

______________________________________________________________________________________________

* ABOUT YOUR HOME *
What is the square footage living space in your home? ________________________________________

How much of this will the foster dog have access to? _________________________________________

Is there any part of your home the dog will not have access to? ______________________________

If yes, where and why? _______________________________________________________________________

Does your home have a fully enclosed fenced yard? Yes [ ]    No [ ]

If yes, describe the fence (height, secured underground, invisible) __________________________

______________________________________________________________________________________________

Is there a gate? Yes [ ]   No [ ]    Can it be locked? Yes [ ]    No [ ]

If there is no fence and gate, please describe how you will keep your dog secure on your 
property.
______________________________________________________________________________________________

______________________________________________________________________________________________

How large is your yard approximately? ________________________________________________________

Do you own a Pool?     Yes [ ]     No [ ]

If yes, is it fenced separately?   Yes [ ]    No [ ]  Above or in-ground? ____________________

* ABOUT YOUR LIFESTYLE *

Is someone home during the day? Yes [ ]    No [ ]

Where will your foster dog be kept most of the time during the day?  Please be specific. 

______________________________________________________________________________________________

Where will your foster dog be kept most of the time at night?  Please be specific.

______________________________________________________________________________________________
Approximately how many hours a working day will your dog be left alone?  And on weekends?

______________________________________________________________________________________________
How often and what months do you go away on holidays?

______________________________________________________________________________________________
Will you have a dog run/dog house? Under what circumstances would you use the dog run/dog 
house?
______________________________________________________________________________________________
What activities do you plan to do with your foster dog?

______________________________________________________________________________________________
Who will be the primary caregiver to the dog? (walks, feeding, grooming, training)

______________________________________________________________________________________________
What do you plan to feed your foster?

______________________________________________________________________________________________
Why do you want to foster a rescued dog? 

______________________________________________________________________________________________
Under what circumstances would you return the foster dog to rescue?

______________________________________________________________________________________________

* DOG PROFILE INFORMATION *
Which of the following best describes the dog that you are looking to foster?
AGE ______________________________
ACTIVITY LEVEL ___________________
GENDER ___________________________
[ ] puppy (6 mos to a year)
[ ] moderate
[ ] male
[ ] teenager(1-2 years)
[ ] active
[ ] adult (2-7years
[ ] veryactive
[ ] senior (8 years)
[ ] no preference

* YOUR OTHER PET INFORMATION *

Have you ever owned a dog? Type (list breed, age, sex) _______________________________________

______________________________________________________________________________________________

If yes, where is that dog now? _______________________________________________________________

Do you have other pets? Type (list breed, age, sex) __________________________________________

Where did your current and previous pets come from? (if applicable) __________________________

Pet Store [ ]   Breeder [ ]   Shelter [ ]   Rescue Society [ ]   Other [ ] ___________________

Are your other pets current on all vaccinations? _____________________________________________

If yes, approx date of pet's last office visit _______________________________________________ 

Are your other pets spayed/neutered? _________________________________________________________

Are your animals on heartworm preventative if applicable, and if so, what type? ______________

______________________________________________________________________________________________

If not, why not? _____________________________________________________________________________

* OTHER INFORMATION *

How did you hear about BCOC Rescue? __________________________________________________________

Have you applied to foster an animal with any other organizations/rescues in the past year?

______________________________________________________________________________________________

List any humane societies, organizations, 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, however, do you realize that often the complete history of a rescued dog may not be 
known and you may encounter some behavioural problems?  Many rescue dogs have problems with
fearfulness, fear aggression, separation anxiety and house training to name a few.  Would you 
be willing to work on retraining your foster dog? Yes [ ]    No [ ] 

* REFERENCES *

Please provide the name, relationship to you, address and phone number of 3 personal 
references (maximum of one family member), as well as your veterinary reference. If you have 
no previous veterinary history, please include a 4th reference (not a family member).
VETERINARIAN
(1) Veterinarian's name & phone number: (or name of the one you intend to use) _______________

______________________________________________________________________________________________

Name under which the animals are registered at the vet's office (pet's name and owner's name) 

______________________________________________________________________________________________
Personal References:
(2) Name & Relationship to you _______________________________________________________________

Phone # & email address ______________________________________________________________________

(3) Name & Relationship to you _______________________________________________________________

Phone # & email address ______________________________________________________________________
_
(4) Name & Relationship to you _______________________________________________________________

Phone # & email address ______________________________________________________________________

(5) If no veterinary reference is available __________________________________________________

Name & Relationship to you ___________________________________________________________________

Phone # & email address ______________________________________________________________________
**********************************************************************************************
Space for additional comments:







**********************************************************************************************
I have contacted my vet and references already. Yes [ ]    Not yet { ], but will have done so 
by (date) ____________________________


By signing this document.................
I/we understand that BCOC Rescue will be responsible for any medical or other approved 
expenses associated with the foster dog in my care.
Note: If injuries or medical treatment is required as a result of negligence on the part of 
the foster home, the foster home will be held responsible for covering the costs of 
treatment.

I/we understand that by signing this form I/we agree to release and covenant to hold 
harmless BCOC Rescue, and its members from any claims, damages, costs, or actions incurred 
as a result of the foster care or actions of the foster dog.  

I/we will notify BCOC Rescue immediately should the foster dog become lost, stolen, and ill 
or die.   

I/we agree to contact my BCOC representative at least once per week to update her/him on 
the condition and well-being of the foster dog.
**********************************************************************************************

BCOC strongly discourages and will not tolerate training or behaviour modification through 
physical violence of any sort.  We will not condone nor tolerate hitting, ˜spanking" or 
any other form of physical punishment. 

All foster dogs must wear an I.D. collar with the foster home telephone number and the 
telephone number of your BCOC Representative at all times.

The foster home agrees to provide high quality food for the foster dog at his or her own 
expense.  Treats, toys, beds, etc. are also the responsibilities of the foster home.  BCOC 
Rescue will try to help with these incidentals wherever possible.

BCOC reserves the right to perform unannounced visits to the foster home at any time. 

BCOC reserves the right to remove the dog from your premises at any time, without 
justification or notification.  Note:  If BCOC judges the foster dog to be in danger, this 
signed document allows BCOC to remove the dog from said premises without warning.  

The foster home understands that BCOC cannot predict the behaviour of any dog in any 
situation. BCOC will provide any relevant information on the dog's history and temperament 
that is known. This information may or may not be a reliable indicator of how the dog will 
behave in a new environment, including your home.
**********************************************************************************************
Home visits are mandatory prior to fostering and may be made on a random basis after a dog is 
placed in your home to foster. If upon inspection we find that information contained in this 
application to be false, we retain the right to turn down your application or remove the 
animal from your premises. We reserve the right to refuse a foster applicant due to our 
primary interest being the well-being of the animal. We require a hard copy of your signature, 
certifying the above information. Your signature also indemnifies the BCOC Rescue, and 
representatives thereof, from any & all liabilities that may occur due to fostering any 
rescues.
**********************************************************************************************
I/We certify that the information provided on this form is true & correct. In signing this 
document, I/we am/are granting permission for a BCOC Representative to contact all stated 
references & veterinarian(s). I/We am/are physically able to care for this foster animal. 
I/We understand that proper food, water and shelter is necessary, and I/we am/are able to meet 
these requirements. 

By typing my/our name(s) here, please consider this as my/our electronic endorsement of the 
veracity of this application.


Signature                                              Date 


Signature                                              Date 

Instructions re. completing and Emailing the above form:
(1.) From the "Edit" drop-down list at the top of your browser (in which you are viewing this form), click on "Select all...."
(2.) From the same drop-down list, click "Copy". (This will now copy the form onto your computer's clipboard.)
(3.) Open your favourite word processor, such as "MS Word", "Open Office", or "WordPerfect".
(4.) Then open a blank document in your word processor. At the top of this word processor program, access "Edit", and click on "Paste". The form now appears in your word processor, and you can complete and edit the form at your leisure.
(5.) At any time, this form can now be "Saved As........", using the following file-naming format.... "YOURSURNAME.FOSTERAPP". Ensure that it is stored in a convenient location on your computer where it can be found easily and readily used as an Email attachment.
(6.) Send an Email to Amy (the National BCOC Rescue Program Co-ordinator) with the Subject: field containing the phrase "YourSurname.FosterApp".
(7.) Attach the above saved file to this Email, and then click "Send".
(8.) An acknowledging Email will be returned to you when the application is read, processed, and filed.


Back To Top Back To Rescue Page
Fight Spam! Click Here!, or Fight Spam! Click Here!, or Fight Spam! Click Here!, or Anti Spam Blocker - Help Fight Spam Email!, or Boycott Internet spam!