Volunteer Application

Contact Information:

First name:

Last Name:

Occupation:

Street Address:

City:

State:

Zip:

Work Phone:

Best time to call:

Home Phone:

Best time to call:

E-mail:

Are you over the age of 18?

Personal References: (No more than 1 family member)

Reference 1:

First name:

Last Name:

Relationship

Phone:

Street Address:

City:

State:

Zip:

Email Address:

Reference 2:

First name:

Last Name:

Relationship

Phone:

Street Address:

City:

State:

Zip:

Email Address:

Reference 3:

First name:

Last Name:

Relationship

Phone:

Street Address:

City:

State:

Zip:

Email Address:

Past Experience and Training:

Have you ever been bitten or attacked by a dog?

Did the bite require medical attention?

If the bite required medical attention, please explain the situation:

Are you comfortable approaching a dog you don't know?

Do you understand that dogs may be unpredictable and that TOTTSHR, Inc cannot guarantee that a dog we are attempting to rescue won't become aggressive?

Are you willing to assume the risks involved with working with animals who are sometimes frightened and who are in unfamiliar surroundings and the possibility that the dog may become aggressive and/or bite you or a companion?

Do you have experience/training in any of the following dog-related areas of work? (check all that apply)

Breeding Grooming Kennel Assistant Animal Rescue Training Vet Tech Pet Store Sales

Other experience and skills that would help you in rescue:

Please describe the nature and extent of above work/training experience?

Please explain or describe any other information, which you feel is relevant or important about yourself:

What type of services have you performed in the past, or are performing now for other volunteer agencies?

Please list dog clubs or rescue organization memberships past and present:

Please list positions held other than general member:

Transportation:

What type of vehicle do you have for transporting dogs?

Are you willing to accept any risk involved in transporting a dog inside your vehicle?

Do you own a crate?

Siberian Husky Experience:

Ownership:

Have you ever owned a Siberian Husky or Siberian Husky Mix?

If you have owned a Siberian Husky, then please describe:

If you have owned a Siberian Husky Mix, then please describe:

Breed Research: (check all that apply)

Have you done any research on the breed?

Yes

I have owned a Siberian Husky

I have read Book(s) about the breed

I have done research on the internet

I have read the TOTTSHR description

A family member owns a Siberian Husky

A friend owns a Siberian Husky

I have talked to people who own Huskies

Other

If you have indicated that you have done other research, please describe:

Pet Ownership:

Past Feline Ownership:

(if you have never owned cats, please click here to proceed to the next portion of the application)

How many cats have you owned in the past 10 years?

Briefly describe what happened to the cat(s) you no longer have:

Current Feline Ownership:

(if you do not currently own any cats, please click here to proceed to the next portion of the application)

How many cats do you currently own?

Are your cat(s) Declawed?

Is your cat an outdoor or indoor cat?

Has he/she ever interacted with dogs?

Please describe your cat(s) interaction with dogs:

Please enter any additional comments regarding your cat(s) here:

Past Canine Ownership:

(if you have never owned dogs, please click here to proceed to the next portion of the application)

How many dogs have you owned in the past 10 years?

Briefly describe what happened to the dog(s) you no longer have:

Current Canine Ownership:

(if you do not currently own any dogs, please click here to proceed to the next portion of the application)

How many dogs do you currently own?

If you currently have dog(s) please indicate the sex, age and breed for each dog:
Dog's Name:
Sex:	Age:	Breed:

Dog's Name:
Sex:	Age:	Breed:

Dog's Name:
Sex:	Age:	Breed:

Dog's Name:
Sex:	Age:	Breed:

Dog's Name:
Sex:	Age:	Breed:

Dog's Name:
Sex:	Age:	Breed:

If you currently own more than 6 dogs, please enter the Dog's Name, Sex, Age and Breed for the additional dog's here:

Other Pet Ownership:

(if you do not currently own pets other than dogs and cats, please click here to proceed to the next portion of the application)

Do you currently own any other animals?

If yes, please list:

Veterinarian Information:

Do you have a regular veterinarian?

Vet Reference:

First name:

Last Name:

Organization:

Phone:

Is this the vet you currently use?

If this is not your current vet please explain:

Volunteering:

Please describe why you are interested in volunteering for a group dedicated to rescuing dogs, particularly the Siberian Husky?

Approximately how many hours per week total do you have available for volunteer activities?

Fostering: Additional Questions for Foster Applicants Only

(Please complete this section if you are interested in becoming a foster home. This would include all foster home types: temporary, short term, surgical, behavioral, and continual. If you are not interested in becoming a foster home please skip to the next section.)

Type of Fostering:

Please indicate which types of fostering you are interested in: (Check all that apply)

Temporary		approx. 1-3 days, these foster homes would be needed in cases where there is a timing issue associated with transport or for a scheduled adoption.
Short Term		approx. 1-2 weeks, these foster homes would be needed in cases of vacations by other foster homes, some timing issues.
Surgical		approx. 2-4 weeks (may be longer depending upon the surgery), these foster homes would be needed in the cases of surgery recoveries, recovering from spay/neuter. Please note that if you have other pets, you may need to have the facilities to keep the foster dog separate during the recovery time.
Behavioral		approx. 1-4 months (time may vary depending on the severity of the case), these foster homes would be needed in the cases where behavior modification is needed in order to make the dog adoptable. The organizations behavioral/evaluation committee will work closely with these foster homes. Please note that if you have other pets, you may need to have the facilities to keep the foster dog separate during the recovery time. TOTTSHR will work to make the dogs in our care adoptable, but it is understood that there are some cases which we are unable to help. In such cases TOTTSHR’s approved policy will be consulted.
Continual		these foster homes are willing to foster a dog until such time as the dog is adopted. The time may vary anywhere from 1 day to 6 months. The foster home will then have the opportunity to foster another dog once the original dog has been adopted.

Fostering Facilities:

Does your home have an outside kennel or other facilities for the temporary housing of restricted dogs?

If yes, please describe:

If you currently own a dog(s), is it necessary for the foster dog to get along with them?

If no, does your home have any means for separating a foster dog from your dog(s)?

Describe:

If you currently own a cat(s), is it necessary for the foster dog to get along with them?

If no, does your home have any means for separating a foster dog from your cat(s)?

Describe:

Fostering Preferences:

Do you have any sex preference for the dog(s) you will foster?

Age preference: (check all that apply)

Under 1 2-3 4-5 6-7 8-9 10 and older

Dwelling Information:

Do you own or rent your home?

If renting, do you have the landlords permission to keep a dog?

Landlord Reference: (If renting, please list the landlords contact information)

First name:

Last Name:

Organization:

Phone:

Please specify the type of dwelling:

If other, then please describe:

Fence Information:

Do you have a fenced in yard?

If yes, then please specify (check that apply):

Under 4 ft. 4 foot 5 foot 6 foot or higher Chain link Picket Invisible Privacy Other

If other, then please describe:

If no fence, how will you handle exercise and toilet duties:

If no fence, do you plan to fence in the yard?

If planning to fence in the yard, when do you plan to do so?

If planning on installing a fence, then please specify (check that apply):

Under 4 ft. 4 foot 5 foot 6 foot or higher Chain link Picket Invisible Privacy Other

If other, then please describe:

Occupants and Ownership Information:

How many adults are in your household?

How many children (under 18) are in your household?

Please indicate the ages of all children:

Who will be the primary caregiver for this dog(s)?

Age of primary caregiver (if under 18):

Is everyone in the household aware of and agreeable to your interest in adopting?

Have your children been taught how to appropriately interact with an animal?

Given the Siberian personality for escaping and roaming, will you teach all household members the importance of never taking the dog out without a lead and the importance of making sure all gates and doors are secure?

Are there regular visitors to your home (human or animal), with which your new dog must get along?

Please describe:

How Foster Dog Will Be Kept:

Where will the dog spend the day? (check all that apply):

Loose indoors Crate Basement Garage Loose outdoors Tied up outside Kennel run Other

If other, then please describe:

Where will the dog spend the night? (check all that apply):

Loose indoors Crate Basement Garage Loose outdoors Tied up outside Kennel run In bed with owner Other

If other, then please describe:

How many hours on average will the dog spend alone?

Other Information:

Do you agree to let a representative of TOTTSHR, Inc. visit your home by appointment?

If No, why not?

Please indicate how you heard about about our organization:

If other, please specify:

Comments:

By pressing the "Submit" button, you hereby agree to abide by the following terms during the time you are rescuing dogs as a representative for TOTTSHR, Inc.:

1. I will not sell or give away any dog in my care to a research facility, pet shop, dog broker or puppy mill, or to any other person, firm or corporation that may cause harm either mental or physical to any dog.

2. I will not use any dog that comes to me through rescue for breeding purposes of my own or allow it to be used by any other person for those purposes.

3. I will remember in all my dealings with the public that I represent TOTTSHR, Inc. and will act pleasantly and answer questions politely or refer persons to someone who can.

I understand all of the above and accept full responsibility for any and all expenses incurred by me during my tenure as a representative for TOTTSHR, Inc. I further agree to keep records of dogs handled, release and adoption forms, moneys collected and expenses incurred for each and every rescue dog. I further agree that TOTTSHR, Inc. may request to view these records at any time. In the event that I resign, voluntarily or by request, I hereby agree to turn the rescue dog records over to TOTTSHR, Inc. within ten days of said resignation. I further agree that upon termination, all rescue records become the property of TOTTSHR, Inc.

I have accurately completed this questionnaire and have read the above warning and appreciate the risks in working with rescue dogs. I understand that TOTTSHR, Inc. cannot be responsible for the actions, behaviors and or medical condition of the dogs that it seeks to rescue and I agree to assume the risks implicit in working with dogs which may have been abandoned beaten or otherwise mistreated or abused or who may suffer from an illness, condition or disease.

Please do not hit the SUBMIT button more than once. You will receive a confirmation page when your application has been processed.

If you have any problems submitting this form please send an e-mail to: webmaster@siberescue.com, and make sure you describe what happened. You can also print out your application and mail it to: TOTTSHR, PO Box 612, Colmar PA 18915.

Thank you for taking the first step towards helping a second-hand dog give first-class love.