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Personal Information

YOUR INFORMATION:

Name:

Age:

Address (no P.O. Box #):

City, State, Zip Code:

How long have you been at this address?

years and months

Home phone:

Work phone:

Cell phone:

Email address:

Employer Name and Address:

Occupation and Job Title:

SPOUSE OR LIFE PARTNER INFORMATION:

Name:

Age:

Employer Name and Address:

Work phone:

Cell phone:

Email address:

OTHER PERSONAL INFORMATION:

List all other adults and children (SCMR has a policy that we not adopt to or approve homes to foster that have children 10 years or younger) living in your home and provide full name, age and relationship:

List all children and their ages who visit your home (grandchildren, neighbors, etc.):

Do you or any member of your family have any on-going medical conditions or physical limitations (including any allergies) that might interfere with fostering a new dog? Yes  No
If Yes, please explain:

Are all family members in agreement with the decision to foster? Yes  No

Do you  own or  rent?

Do you have the permission of your landlord to have a dog?
Yes     No

If Yes, please provide your landlord's name and phone number:

Do you have a fenced yard attached to your home?

Yes

If Yes, describe your fence, including material it is made of and general size:
    

No

If No, please describe how you plan to potty your foster dog:
    

Are your dogs always supervised when they are outside?

Yes

No

    If No, explain:
    

Do you have a swimming pool? Yes     No

If Yes, is it fenced separately?

Yes     No

If No, please describe in detail how an SCMR rescue would be kept safe from the pool area:

Pet History

Describe previous pets and what happened to them:

Do you currently own other pets?

Yes

If Yes, please give a brief description of each one (dog/cat, breed type, weight, spayed/neutered, temperament, etc.)

No

Have you ever fostered dogs before?

Yes     No

If yes, what group were you working with?

Can you isolate the foster dog from your other pets initially or in the event that they cannot get along?

Yes

If Yes, describe how:

No

Do you ever use a crate or Xpen for your pets?

Yes

If Yes, describe when:

No

How many hours a day will the foster dog be alone?

Where will the foster dog be kept when you are gone?

Where will the foster dog sleep at night?

Do your other dogs have any medical issues?

Are your dogs/cats current on shots and vaccinations?Yes  No

Do you test for heartworm every year and keep your pets on heartworm preventative medication?Yes  No

Which heartworm preventative medication?

Do you use flea preventative on your dogs?Yes  No

If Yes, how often and which one?

Family/Lifestyle

Is everyone in your family agreeable to you fostering this dog?Yes  No

If No, who is not?

If you go on vacation, who will take care of the Maltese?

Will you pick up a dog from a home or shelter if that is needed?Yes  No

How far are you willing to travel to pick up a foster dog?

Are you willing to participate in transport if one of our dogs needs to be moved across state(s)?Yes  No

There may be times when you are asked to foster more than 2 Maltese. Are you willing to do this?Yes  No

Will you accept a permanent foster Maltese?Yes  No

Care of Maltese

Do you understand the temperament, socialization, grooming, health issues and proper care of a Maltese?Yes  No

Do you understand that the foster dog must live in your home as a loved family member and is not an outside dog?Yes  No

If you have to pick up a dog that is coming into our rescue care, it may have ticks and fleas, have an illness or infection and badly matted hair. Are you prepared to deal with such a situation, to treat, care for, bathe and groom this Maltese?Yes  No

Do you realize that you may have to foster for months or an indefinite time until the dog is ready or able to be placed?Yes  No

Foster homes may have to deal with behavior issues. These may include things such as house training, excessive barking, fear of children, submissive wetting, marking territory or nipping at heals. Dogs that come from a puppy mill may have very different behavior patterns than dogs that are surrendered by an owner. Do you feel you are capable and prepared to deal with any behavior issues?
Yes  No

Do you understand that you are expected to administer any medication or treatment the dog may need?Yes  No

If the dog has aggressive tendencies through fear or dominance issues do you feel capable of handling the situation and able to help retrain the dog?Yes  No

Do you have any experience with this?Yes  No

Maltese need to be brushed several times a week if their hair is long. Are you prepared to do this? (SCMR cannot pay for grooming expenses on foster dogs)Yes  No

Do you understand that you are expected to review applications and participate in the selection of the forever home for your foster dog?Yes  No

Personal References

Please give us the names of two (2) personal references (not relatives):

Name:

Phone:

How do you know this person?

Name:

Phone:

How do you know this person?

Southern Comfort Maltese Rescue will contact your veterinarian. You may wish to contact him/her prior to our call and give permission for us to discuss your past pet history. SCMR will only approve applications that provide a current veterinarian reference, it is important to know that a new volunteer has a history and working relationship with a veterinarian. If there is not a current reference, perhaps another way to volunteer and work with SCMR would be a better fit.

Veterinarian Business Name:

Phone Number:

Address:

City, State, Zip Code:

All the information in this application is true and correct. I understand and agree to abide by the terms and conditions herein. I understand that any misrepresentation of the facts may result in my not being approved to provide Maltese foster care or the removal of the foster dog from my home by Southern Comfort Maltese Rescue.
Yes  No

If submitting this application online, please click on the button below. A signature is not required.

Signed: _________________________

Dated: __________________

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This Agreement may be executed in one or more counterparts, each of which will be deemed to be an original copy of this Agreement and all of which, when taken together, will be deemed to constitute one and the same Agreement. The exchange of copies of this Agreement and of signature pages by facsimile or other electronic transmission shall constitute effective execution and delivery of this Agreement and may be used in lieu of the original Agreement for all purposes. Signatures of the parties transmitted by facsimile or other electronic transmission shall be deemed to be their original signatures for all purposes.

If you prefer to submit via snail mail, please sign and send to:

SCMR
P.O. Box 2005
Chattanooga, TN 37409

(updated: 09/04/19)