Name:

Address:

City-State-Zip:

Home Phone:

email address:

Please retype email address:

Do you own or rent your home. Own Rent

How many members are there in the household:

If there are children, what are their names and ages:

Do you have a fenced yard: Yes No

If a pet is placed in a foster situation with you, Cherished Cockers will provide routine and emergency veterinary care through designated veterinarians. Foster dogs are not to be treated by unauthorized veterinarians except in cases of extreme emergency. Expenses resulting from unauthorized routine care will be the responsibility of the foster parent.

All foster dogs are to be kept indoors only, with adequate food, water and attention. Do you agree to make a commitment to care for the dog until a permanent home can be located. Yes No

Approximately how many hours a day will your foster dog be alone?

Where will the foster dog spend the day while you are away?

Where will the dog sleep?

Do you have the knowledge and time required to housebreak and/or obedience train the pet if the situation should occur that it becomes necessary? Yes No

Do you presently have any animals, if so, please list those currently residing with you (type of animal, age, sex, neutered/spayed, and how long you have owned them: Are they all inside animals? Yes No

Please tell us a little about yourself, and why you would like to foster.

Please provide three references including your present veterinarian, if applicable. Please provide current addresses and telephone numbers of your references. Name: Address: Phone: Name: Address: Phone: Name: Address: Phone:

In consideration of this opportunity to foster, I agree to the following terms and conditions, intending to be legally bound by them: I will abide by the mission, rules, regulations, policies and programs of the Cherished Cockers, Inc. while I am a foster. I assume the risks of being bitten, scratched, injured or frightened by dogs and puppies or other Cherished Cockers animals in connection with my foster work for Cherished Cockers. The Cherished Cockers organization, officers and volunteers are not liable to me for any injuries, damages, liabilities, losses, judgments, costs or expenses which I might suffer or sustain in connection to the performance of my foster activities for Cherished Cockers unless they are the result of Cherished Cockers' gross negligence or intentional misconduct. I will indemnify, defend and hold Cherished Cockers harmless from and against any claims, lawsuits, injuries, damages, losses, costs or expenses sustained by any companion animal or any person in connection with my intentional misconduct or grossly negligent performance of foster activities for Cherished Cockers, or my breach of Cherished Cockers' rules, regulations, policies and programs. If I suspend foster activities, or upon Cherished Cockers' request at any time, I will promptly return all Cherished Cockers supplies, equipment, records, moneys and other items in good, clean condition. I will not have a person outside Cherished Cockers organization temporarily care for Cherished Cockers' animals (i.e. a visitor, pet sitter, neighbor, relative) unless the person first signs a Hold Harmless Agreement to hold Cherished Cockers, its officers and volunteers harmless in the event of injury or mishap. In the case of an adoption, an Adoption Agreement is to be signed. Any modification to this Agreement must be in writing and signed by both parties. This Agreement is binding upon Cherished Cockers, Cherished Cockers' representatives, me and my respective heirs, successors, assigns, executors and personal representatives. I agree to all the terms stated above. I will abide by them and not dispute or take issue with them in any way

Signature: (For purposes of this application, printing your name is equivalent to a signature.)

Date: