NORTHCENTRAL MALTESE RESCUE, INC.
FOSTER CARE APPLICATION AND CONTRACT

If you are interested in providing foster care for Northcentral Maltese Rescue, Inc., please fill out this form and send it to:  Mary Palmer, 5311 Douglas Ave., #124, Racine, WI 53402. There is no fee to apply to become a foster parent. Fostering is a very important part of our rescue program. This is a comprehensive application which may seem formal, but it is necessary for the safekeeping of our dogs.

(please print)
Date:                                                                   Referred to NMR by:

PERSONAL INFORMATION

Name:                                                                  Age:

Address (no P.O. Box #):

City, State, Zip Code:

Home Phone:                                                        Work Phone:

Email Address (print clearly):

Occupation and Position Title:

Employer Name and Address:

Employer Phone Number (to verify employment):

Work schedule:

Significant Other Name:                                            Age:   

Occupation and Position Title:

Employer Name & Address:

Employer Phone Number:

Email Address:Work Phone:           

Work schedule:

Why do you think you are a suitable candidate to provide foster care for a Maltese rescue?



YOUR FAMILY
1. If you do not have a significant other, circle one:    Single       Divorced        Widow(er)       Other:
   If single:    Live alone      With family      Other arrangement:

2. List all other adults and children living in your home:  (use extra space on back if needed)
Full Name   Age Relationship         Occupation & Work  Schedule (or Year in School)




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


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

While some people are less allergic to Maltese than to other breeds, there is no guarantee that a Maltese will not cause an allergic reaction.

4. What concerns have been voiced by other family members about providing foster care?

YOUR  HOME
5. Do you own?  Yes    No        House      Condo      Townhouse     Farm     Other:

6. Do you rent?  Yes    No        House     Apartment     Condo     Townhouse       Other:

7. If renting does your landlord and/or tenants' association permit pets?  Yes   No   Please supply the following for verification:
Landlord/managing agent name:     
Phone Number:

8. Do you have a fenced yard attached to your home?   Yes   No     If yes, describe your fence. What type is it and what is the area available to the dog?

9. If there is no fence, how do you plan for the dog to relieve itself?

10. Do you have a pool?    Yes   No          If yes, is it fenced separately?    Yes    No

11. Are you aware of any distractions outside your yard that could be a hazard to the dog? (e.g., neighbors' dogs, unleashed dogs, wild animals, mischievous children)?  Yes   No    If yes, please explain:

12. Can strangers gain access to your yard from the streets?   Yes    No     If yes, how:

13. Do you plan to move in the near future?   Yes   No    When:                           Where to:

PET OWNING HISTORY
14. Do you have or have you had Maltese?   Yes  No     If Yes, where did the dog come from, how long did you have it and what happened to it?

15. Have you ever owned other dogs?  Yes   No    If Yes, how many years have you owned dogs and give a brief history of each one:

16. Have you ever fostered Maltese or other dogs before?  Yes   No   If yes, what group were you working with?:

17. List all dogs currently in your home (use extra space on back if needed):
Age   Sex  Altered?   Weight   Breed    Had How Long?      Temperament - Submissive or Aggressive





18. How do you think your dogs will act with or react to a Maltese rescue?

19. List all other pets (including exotics) currently in your home (use extra space on back if needed):
  Age   Sex   Altered?  Weight   Type                         Temperament



20. Please explain how you handle behavior problems past or present with your animals:

21. Can you isolate the dog from the other animals if they cannot get along?    Yes    No    How do you plan to do this?

22. Do you ever crate your pets?   Yes    No    When?

23. How many hours a day will the foster dog be without people? (Be realistic and do not count time spent with dog on lunch breaks)

24. If you are home for lunch, state the actual amount of time you are home:   

25. Where will this dog be kept when you are gone?  

26. Where will the foster dog sleep at night?

27. How often do you walk your own dog(s)?          Daily        times a week        Seldom        Never

28. Are your dogs always supervised when they are outside?    Yes    No     If No explain:

29. Have you ever completed an obedience class with your dog(s)?    Yes    No      To what level?

30. Are your dog(s) current on shots and vaccinations?    Yes    No    If Yes, list:

31. Do you test for heartworm every year?  Yes  No    Are they on heartworm medication?   Yes   No   Which?

32. Do you use flea preventative on your dogs?    Yes   No      If Yes, which one?

YOUR LIFESTYLE
33. Is everyone in your family willing to help with the care of this dog?   Yes   No     Who is not?

34. Do you understand that a Maltese is an indoor dog and is never to be left outside alone? Yes  No

35. Who will be responsible for the Maltese when you are away more than 3-4 hours?

36. If you are away for a few days or go on vacation, who will take care of the Maltese?

37. What will the routine be if dogs do not go on a trip?

38. You may be asked to pick up a dog from a home or shelter. Will you do this?    Yes      No

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

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

41. Occasionally we rescue two Maltese, and these dogs must stay together. Are you willing to accept 2 foster dogs?   Yes   No

42. There may be a rare instance where you are asked to foster more than 2 Maltese. Are you willing to do this?    Yes    No

43. Complete these sentences: 
I can easily handle         foster dogs at one time. 
I do not want more than      foster dog(s) at one time.
I will accept a permanent foster Maltese:     Yes    No   

CARE OF THE FOSTER MALTESE
As you prepare to answer the following questions we want you to understand that a Northcentral Maltese, Inc. representative will be available to guide and assist you if you need help. It is important for you to understand that you will not be alone once you have a foster dog in your home.  You will be in constant contact with a coordinator or board member.

44. Have you taken the time to learn and do you understand the temperament, socialization, grooming, health issues and proper handling requirements of a Maltese?    Yes   No

45. Do you understand that the foster dog must live in your home as a loved family member?    Yes    No

46. Do you realize that the Maltese should not be closed off in a separate room from your family?    Yes    No

47. Do you understand that no physical punishment is to be used on this Maltese and that you will contact a Northcentral Maltese Rescue, Inc. representative if behavior problems arise?    Yes    No

48. If you have to pick up a dog, 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      

49. Do you realize that you may have to foster for a month or more until the dog is ready or able to be placed?   Yes    No

Foster care providers may have to deal with behavior issues.  These may include but are not limited to house training, excessive barking, fear of children, submissive wetting, marking territory or nipping at heals. 

50. Do you feel you are capable and prepared to deal with any behavior issues?   Yes    No

51. Do you understand  that dogs that come from a puppy mill may have very different behavior patterns than dogs that are surrendered by an owner?    Yes    No     

52. Do you realize that some foster dogs may have been abused and you will be expected to help the dog learn to trust humans again?    Yes    No

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

54. Do you understand you are expected to socialize the dog if needed, helping it to adjust to your new environment?   Yes   No  

There are two main reasons why a Maltese bites: one, they bite out of fear, and two, they bite because of a dominance issue. Biting out of fear requires a gentle and calm hand to gain the dog's trust. If the biting is caused by a dominance issue, you must take the role of alpha dog to stop the behavior.

55. If the dog is known to bite are you prepared to handle the situation by becoming alpha dog?    Yes   No    
      Do you know how to do this?  Yes   No        Would you ask for instructions?    Yes   No

56. Maltese need to be brushed several times a week if their hair is long. Are you prepared to do this?  Yes  No 

57. Do you have the proper tools and products for bathing, brushing and grooming? Yes  No   If No will you get them? Yes  No  

58. If you send a dog to a groomer do you understand it is at your own expense? (for exceptions see Foster Guidelines) Yes  No

59. Maltese have daily exercise requirements. Do you understand these needs, and are you prepared to meet them?    Yes   No

60. Do you have all the necessary equipment to make this dog comfortable (crate and/or exercise pen, blanket or other soft bed to rest on, bowls, leash, harness, etc.)?   Yes   No     If you are in our area we may be able to provide some items.

61. Do you understand that you are expected to contact a Northcentral Maltese Rescue, Inc. representative if you need help with any problem?    Yes    No

62. Please describe any other arrangements you have made to provide for the needs of a foster Maltese:

PERSONAL REFERENCES
63. 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?

64. Northcentral Maltese Rescue, Inc. will contact your veterinarian. Please contact him/her prior to our 
call and give permission for us to discuss your past pet history.

Veterinarian Business Name:

Phone Number:

Address:

City, State, Zip Code:

65. We will also contact your groomer. Please contact him/her prior to our call and give permission for 
us to discuss your past pet history.  

Groomer:

Phone Number:

Address:

City, State, Zip Code:

Please use this space for any additional information you feel is important.



All the information in this application is true and correct, and 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 Northcentral Maltese Rescue, Inc.

Signed:                                                                Date:

Return this application and the Foster Care Contract with your signatures on both documents to: Northcentral Maltese Rescue, Inc., c/o Mary Palmer, 3601 Wright Ave, Racine, WI  53405. Feel free to include pictures of your home and family if you have them. You will be contacted by the Northcentral Maltese Rescue, Inc. President or a Board Member for a telephone interview and a home visit if possible.

Before a dog can be placed in your home you must sign and send us the Foster Care Contract which is included below.


FOSTER  CARE  CONTRACT

I,                                               , do hereby enter into this contract with Northcentral Maltese Rescue, Inc. of my own free will and agree to give foster care and shelter as a temporary custodian to rescued Maltese dogs for a limited period of time. I further know and understand that Northcentral Maltese Rescue, Inc. does not have complete prior knowledge of the rescued dogs' health and temperament, and I shall take all necessary precautions to protect myself and others who might come into contact with the dog(s). I understand and agree that I shall not hold Northcentral Maltese Rescue, Inc. responsible for any injury, illness or disease contracted by any dogs or other animals privately owned, or for property damage or harm to other dogs or persons who may come into contact with a foster dog(s) while it is in my care. In addition, I shall not damage the reputation of, or make slanderous or insulting remarks about Northcentral Maltese Rescue, Inc. with the intent to harm the integrity of the organization.

1.  I agree that the dog(s) I am fostering shall not be removed from my address or disposed of, and I shall immediately contact Northcentral Maltese Rescue, Inc. and return the foster(s) immediately should some problem or circumstance arise and I am no longer willing or able to care for, look after or keep the Maltese in my home in the manner which Northcentral Maltese Rescue, Inc. expects from its foster care providers.

2.  I understand that Northcentral Maltese Rescue, Inc. shall be responsible for the payment of all necessary veterinary care of the Maltese while the dog is in my care, but any veterinary visit cannot be made without prior approval from the Northcentral Maltese Rescue, Inc. President or Vice President, except in the case of a life or death emergency. I shall keep a record of the approval with the date. I further understand and agree that I may be asked to pay for all veterinary care, if necessary, until such reimbursement of funds is made by Northcentral Maltese Rescue, Inc. I shall maintain clear and accurate records of all expenditures and keep original receipts, and I realize that no reimbursement shall be made until all such records are received by Northcentral Maltese Rescue, Inc.

3.  I understand that no payments of any kind for any type of service will be reimbursed before the foster dog is adopted unless approved by an Executive Committee Board Member (Mary Palmer 262-633-9371 or Trudy Peischl 509-968-9001) under special circumstances. In order to be reimbursed for expenses for the foster dog(s) I shall itemize on a separate sheet: the date of the expenditure, the date of approval given by the Board Member for that expenditure, a clear explanation of what the expenditure was for and the total amount to be reimbursed. I shall submit this to Northcentral Maltese Rescue, Inc. along with the original receipts and approval documents.

4.  I am fully aware that under no circumstances shall a Northcentral Maltese Rescue, Inc. Maltese be bred or be allowed to bred, and I shall take all necessary precautions to prevent this from happening. I agree to keep all Northcentral Maltese Rescue, Inc. dogs in safe, sanitary and healthy conditions and to provide them with love and attention to help them overcome any fear or aggressiveness that causes unacceptable behavior. I understand and agree that all Northcentral Maltese Rescue, Inc. rescued dogs must be spayed or neutered and be provided with basic medical care as outlined in the Foster Care Guidelines before a placement is made.

5.  I understand that under no circumstances does Northcentral Maltese Rescue, Inc. pay for boarding at a foster home. This is a volunteer organization that does not pay foster care providers for their time or services in any way.

6.  I shall, upon request, release any Northcentral Maltese Rescue, Inc. foster dog to a representative of the organization within 24 hours of the request by a Northcentral Maltese Rescue, Inc. officer or their representative.

7.  I understand that I have no authority to place, move or promise any foster dog in my care to any home without permission from an officer of Northcentral Maltese Rescue, Inc.  This includes returning the dog to its original owner.

8.  In the event of abuse or injury to any of the foster dogs, or damage to the reputation of Northcentral Maltese Rescue, Inc., I accept that I may be liable for $1000.00 liquidated damages for breech of contract.  In the case of a breech of contract, the foster dog(s) must be returned immediately, with all paperwork included, to Northcentral Maltese Rescue, Inc. at my sole expense. This contract shall be governed by the laws of the State of Wisconsin.

9.  In the event I wish to adopt a dog I am fostering, I understand that as a foster I must apply as any other potential adopter, and I must follow all Northcentral Maltese Rescue, Inc. adoption procedures. I know adoptions are only approved by the President/Rescue Coordinatoror or the Vice President. 

I enter into this contract with Northcentral Maltese Rescue, Inc. with the full knowledge that I will be responsible for the safety and well-being of the Maltese while it is in my care, and I shall abide by all agreements and understandings set forth in this Foster Care Application and Contract.

Foster  Signature(s) 

Email Address (print clearly)                                                                         Telephone

Northcentral Maltese, Inc. Representative

Date

If you have any questions regarding this agreement and contract, please contact Mary Palmer, Rescue Coordinator, at 262-800-3323. If you can't contact Mary, call Trudy at 509-968-9001.