Adoption/Foster ApplicationStep 1 of 812%This application was designed to help us get to know you and to help you find the right dog for your family. If some of the questions seem personal, that's because the more we know about you the more confident we will feel considering you to adopt one of our foster dogs or referring you to a dog available elsewhere. Please feel free to ask questions of your own.If you’re applying to adopt a specific foster dog from NYCSR, please list their name here, along with why you feel this is the right dog for you or your family.PERSONAL INFORMATION1st Applicant Name:Date of Birth:Street Address:WorkCellEmail:City, State ZIPPhone:2nd Applicant Name:Residency Information:How long have you lived there?Do you have plans to move?Do you have a fenced yard? (Yes / No)If yes, fence material and height?Do you have a crate?Are you willing to crate train if needed?Will you allow a home visit by rescue personnel upon request?Family and Friends:Do you have other adults living with you? If so, please list them.Do you have any specific dog-related skills?Who will be the primary caretaker of the dog?Do you have children who live with you or visit your home on a regular basis? If so, please list their first name and ages. Are they experienced around dogs?Is anyone in the home allergic to dogs?Is anyone in the home afraid of dogs?Does everyone in your family want a dog?Professional Information:What is your occupation?How far from home do you work?How many hours per week do you work?Other adult in household’s occupation?How far from home do they work?How many hours per week do they work?Do you have a car?Budget and Finances:Do you feel you are financially and physically able to care for a dog for its lifetime?Are you willing and able to consider a “special needs” dog?Are you willing to take a dog with kennel cough?A dog that is injured?A dog with behavior problems?A dog that is aggressive?A dog that is not housebroken?A dog with a litter of puppies?Puppies being bottle fed?Other Pets:Have you ever owned a dog(s) before?If so, How many?What were their breed(s)?What happened to them if don’t still have them?If they have passed away, please explain how?Do you currently have any other pets?If yes, what kind(s)? (please list breed, gender, age and describe each temperament)Are they spayed/neutered and up to date with vaccines & preventative care?About Your New Dog:Why do you want to adopt a dog?Who is this dog for?Why do you want a Shiba Inu in particular?What do you know about the Shiba Inu breed?Where did you learn about the breed?Have you discussed with your family the pros and cons of owning a Shiba?What other breeds have you been considering?What age range are you looking for?Why?Do you have a preference for male or female?Do you have a color preference?Are you willing to consider a Shiba MIX or only a purebred dog?Your New Dog’s Environment, Socialization and Training:Will the dog be in contact with any other pets outside your home? (Please explain)What do you expect your daily routine to be with your new dog? (Please describe)How much time will be spent with your dog daily on weekdays?How much time will be spent with your dog daily on weekends?How many hours will your dog be left alone daily?Where will your dog be when you work?Where will your dog sleep?Will your dog be crated or restrained?Do you have a separate area to isolate the dog for health reasons if necessary?Is your lifestyle such that friends, relatives and children gain admittance to your home, property, and/or car without your supervision?How often will your dog be walked?Where, how and by whom?How often will your dog be played with?By whom?Who will care for your dog if you are away overnight or on vacation?What are your training objectives? What kind of work or behaviors do you expect of this dog?What amount of time and effort do you expect to devote to training him/her?Which family members will be expected to assist with home training?Will you take your dog to obedience training classes?Have you chosen a trainer or school? If so, who?:What is your definition of disciplining a dog?Describe two pet behavior problems that you have worked through and how you solved the problems:Are there any unusual circumstances to which your dog will need to adapt?Do you have any other comments regarding your daily routine?Who is the Veterinarian that will be caring for your dog?Clinic Name:Vet's Name:PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country References (MANDATORY)Please list two personal references. If possible, please list individuals who are active in the dog community and are knowledgeable about your care of dogs, such as a trainer, veterinarian, breeder, active rescue volunteer, etc. DO NOT LIST FAMILY MEMBERS.1st Name First Last PhoneEmail2nd Name First Last PhoneEmailPlease feel free to add any other information you think would be useful for us to know or make any comments that you would like to add.Terms of the Foster Volunteer AgreementI, hereby acknowledge the following policies and agree to abide by them during the entire time I am fostering dogs for NYC Shiba Rescue, Inc. (NYCSR)I understand that my role is solely as a temporary home, and that although my opinion regarding the match between the foster dog and potential adopters is very important, the ultimate placement of any dogs I foster will be conducted by NYCSR. It is NYCSR's responsibility to review and interview potential adopters.I will remember in all my dealings with the public as a foster volunteer that I represent NYCSR, and that the public will consider my words and actions to be representative of the attitudes and positions of NYCSR as an organization. I understand that as an individual, I am not authorized to speak for NYCSR, nor can I enter into any agreements for NYCSR; any such activity will be referred to the Board of Directors.I have read, understand and support the mission of NYCSR.I understand that I am personally responsible for any and all financial expenses that I incur in my efforts to foster dogs for NYCSR. Although NYCSR may reimburse my expenses, I agree that each expense must be supported by receipts, must be pre-approved by the Foster Program Director, and that any expense over $200 for a single dog must also be preapproved by the Board of Directors. I accept full responsibility for any expenses incurred by me that fall outside of approved expenditures. I will always remember that I represent a nonprofit organization and in no way can profit from any activity related to the organization.I agree to not leave an NYCSR foster dog in anyone else’s care unless that person is approved to Foster by the Foster Program Director or other NYCSR Board memberI agree to not take any other dogs into my care or home – short or long term – during the time I am actively fostering for NYCSR without written approval from NYCSR.I understand that NYCSR cannot guarantee or be held responsible for the temperament, behavior, or health of foster dogs that I may handle. I am aware that foster dogs may cause damage to my personal property, other pets, and humans. I will keep dogs securely contained at all times while in my care.I understand that it is my decision to foster dogs for NYCSR. I will not hold NYCSR liable for any damage, injury or harm caused directly or indirectly through my fostering activities with NYCSR. I carry insurance coverage in the event of personal or liability damages resulting from fostering dogs for NYCSR.I understand that my foster volunteer position will be terminated if my conduct is deemed in opposition of the mission of NYCSR, or detrimental to the best interests of the dog(s) in my care or of NYCSR.I understand and agree to all of the above, and support the mission of NYCSR. I understand that this form must be received and approved by NYCSR before I may volunteer for the organization, and that NYCSR reserves the right to refuse my application.Name:Date:
