After you have read the description of our Foster Home Program, please complete the questions below, sign and return to Houston Collie Rescue. Thank you for helping with this greatest of rescue needs.

Name: ________________________________
Address: ______________________________
City: ________________State: ____________
Home Phone:(_____)_______________

Occupation: ____________________________
Work Phone:(_____)_______________

E-mail:_______________________________ Cell Phone:(_____)_______________

1) Do you live in a house?_____ Apartment?_____ Condo?_____ Trailer?_____ Do you rent?_____ Own?_____

If you rent, do you have the landlord’s permission to keep a dog? __________

Do you have a yard? _____ Is it fenced? _____ Height: ______

What type of fencing? Chain: _____Wood: _____ Other: ___________

2) Is someone home during the day? _____ Please explain: ____________________

3) What provisions will be made for your foster Collie if no one is home during the day?

Loose inside: _____ In crate: _____ In fenced yard: _____

4) Where will the Foster Collie sleep? Please explain:______________________________

5) Please explain your responses below. During the last two years:

Have you lost a pet (not through death)? __________

Have you had a pet poisoned? __________

Have you had an animal killed by a vehicle? __________

Have you had an animal die due to disease? __________ If yes, what did the animal die of?

___________________________________________________________

6) Do you have children at home? _____ Number:_____ Age(s): __________

7) Do you have other pets at home? _____ Number: _____ Ages(s): __________

8) If yes, are the pets neutered? __________

(If resident pets are not neutered, please explain as HCR prefers not to place our dogs into un-neutered homes.) This will help us determine which Collie to put into a potential new foster home.

___________________________________________________________

9) If yes, are the pets vaccinated and on heartworm preventative? __________

9A) Phone number and name of your Vet: __________

9B) What name are medical records listed under at the Vet's Office? __________

10) Do your pets get along with other animals? __________

11) Houston Collie Rescue will provide all medical care, heartworm and parasite preventative. Are you prepared to assume the responsibilities of feeding, bathing, grooming and caring for your foster Collie, including emotional rehabilitation for a traumatized dog and crating for a dog going thru heartworm treatment? __________

12) Will you follow all Veterinarian instructions provided and administer all prescription medications and Heartworm Preventative to your Foster Collie? __________

13) Are you prepared to keep your Foster Collie crated if going thru Heartworm treatment? __________

14) Are you prepared to assume the responsibilities of contacting Houston Collie Rescue Coordinators for any medical emergencies? (For example, if a dog is going thru Heartworm treatment and begins throwing up and becomes listless, this may be an emergency). __________

15) Will you let Houston Collie Rescue Coordinators know if you are planning to take your foster Collie out of town or state for family visits or recreation? __________

16) Though Houston Collie Rescue does not accept vicious dogs into our program, we do not know the histories of many of our rescues. Are you prepared to contact Houston Collie Rescue immediately if your Foster Collie bites anyone or seriously injures another pet? __________

17) Will you keep the dog confined in a fenced yard when let outdoors, walk/exercise the Foster Collie regularly and allow the dog indoors? __________

18) Do you understand that Collies are known for being "barkers"? __________

19) Do you understand that Collies can be shy and aloof with new people? __________

20) Do you understand that Houston Collie Rescue Coordinators may place your Foster Collie in an adoptive home? __________

20) Foster parents are encouraged to maintain an "Aunt" or "Uncle" relationship with the Collie in their care. However, occasionally the foster parent and the Collie will bond so completely that adoption into this home is best for the Collie and family. Do you understand that if you wish to adopt your Foster Collie you must complete the Adoption Application & Adoption Agreement and pay the $250 adoption fee for dogs under age 10, $125 for senior dogs over age 10, and $275 for puppies under 12 months, $125 for Collie Mixes? __________

21) Are you willing to allow a Houston Collie Rescue Coordinator to visit your home by appointment? __________

22) How did you hear about Houston Collie Rescue?

1. Internet Search ___________
2. Vet, Clinic, or Shelter Referral _____ Name: _____________________
3. Breeder ______ Name: ________________________
4. Dog/Obedience Club ______ Name: __________________
5. Another Rescue Group ______ Name: ________________
6. Friend/Neighbor ______
7. Other _____ Please explain: ___________________________________

I am in full agreement with Houston Collie Rescue Foster Care Responsibilities. By signing below I am attesting to the truthfulness of my answers.

Date: _______________________________

Signature: _______________________________

H.C.R. Coordinator: _______________________________

Houston Collie Rescue
PO Box 526
Stafford, TX 77497-0526