Foster Application Form

Cocker Foster Application Form

First Name

Last Name

Address *applications with no address listed will not be processed

State

Home Phone

Postcode

Mobile

Identification - Drivers licence or Passport will need to be sighted

PEOPLE LIVING AT THE PREMISES

How many adults?

How many children?

How old are the children?

HOME CHECK

We conduct home checks for the purpose of ensuring that the environment is secure, safe and suitable for a Cocker to be kept in. If during the process of checking a potential carers home it is found to be unsuitable, Cocker Spaniel Rescue Australia (CSRA) are happy to work with applicants to address the issues. If a physical home check is not possible CSRA Inc must be provided pictures of your home, and a referee for us to contact.

QUESTIONNAIRE

We ask all potential foster carers to complete a questionnaire so that we can find out more about you, your family and your circumstances. This ensures that the right Cocker is placed with you, so that fostering is a positive experience for all involved.

Do you currently have any pets? If yes, please specify

Are your pets desexed?

Do your current pets (if any) have any behavior or socialization problems? If so, please explain:

Are you able to provide short term, emergency foster care?

Are you able to provide long term foster care, if required?

Are you willing to foster a dog who is not a cocker spaniel if required?

What are your working circumstances? How long will the cocker be home alone each day?

Do you rent or own your home? If renting please provide Landlord's contact details for CSRA to verify approval to house pets

Do you have a securely fenced yard?

Do you currently have a vet? If so, please provide us with their name and phone number so that we can contact them for a reference.

THIS FORM CONSTITUTES A LEGAL AGREEMENT:

Before you submit it please read this carefully:

By submitting this application, I agree that all the information I have provided is correct. Providing untruthful answers or failure to comply with the requirements of this application can result in the rejection of the application. If said information is found to be misleading or untrue after the Cocker has been placed, I agree that the Cocker will be returned to Cocker Spaniel Rescue Australia immediately.

By signing and submitting this form, I agree to the following:

I agree that the Cocker will NOT be an outside dog.
I agree that the Cocker will NOT be used for breeding.
I agree to allow CSRA to check the references that I provided.
I agree to give CSRA at least 72 hours notice if I am no longer able to foster the dog (unless due to extenuating circumstances).
I will request in writing any items that my foster dog needs, to CSRA administration for consideration
I will follow any and all directions from CSRA regarding medical/behavioural or grooming care
I will feed my foster dog a well balanced diet, (no vegan/vegetarian diets are permitted)

By signing and submitting this form, I understand the following:

I understand that I am responsible for providing food, shelter, love and care for the Cocker. CSRA will cover any veterinary, grooming or training costs that may arise. I will contact CSRA before obtaining any veterinary treatment for the Cocker in my care and CSRA will not unreasonably withhold approval for such treatment.
I understand that at all times during the foster care period, the Cocker belongs to CSRA. CSRA assumes full ownership of any Cocker in foster care from the moment the dog is surrendered.
I understand that in the course of my role as a foster carer with CSRA. I am to maintain confidentiality at all times. I will not discuss anything regarding the dog(s) with their former owner or anyone else, nor will I discuss any of CSRA’s policies, communications or any other business. I will direct any and all enquiries to CSRA administration
I understand that even after signing this form, I have the right to say no, and am under no obligation to foster a dog, if requested by CSRA.

LEGAL LIABILITY

Upon submitting this application I ACKNOWLEDGE AND AGREE that during the foster care period:

I will be the person responsible for the control of the dog for the purposes of Section 6 of the Dog and Cat Management act 1995 (SA) (“the Act”) and, accordingly, I will be required by law to carry out the functions imposed by the Act. This includes, but is not limited to, ensuring that:
- I exercise effective control of the dog
- The dog does not wander at large
- The dog is on a lead (not exceeding 2 metres in length) when in a public place
- The dog is either (1) on a lead; or (2) under effective control by command, in close proximity and in full view at all times when in a park
- The dog does not attack, harass or chase any person or any animal owned by or in the charge of another person
- The dog does not injure or damage the property of another person
- The dog does not create a noise by barking or otherwise which unreasonably interferes with the peace, comfort or convenience of a person
- I obtain permission of the person in charge before taking the dog into any school, pre-school or child care centre, or any shop (other than a pet shop or grooming parlour)
- If the dog defecates in a public place I will immediately remove the faeces and dispose of them in a lawful and suitable manner
- The dog is appropriately restrained if transported in the open tray of a vehicle

I will be the “keeper” of the dog for the purposes of section 66 of the Act and accordingly I will be responsible in tort for injury, damage or loss caused by the dog

[a full copy of the Act is available at http://www.legislation.sa.gov.au

I will assume all legal liability for any personal injury or property damage caused by the dog and sustained by me or any other person during the foster care period
I will ensure that I have adequate insurance cover in respect of such liability
I waive my rights to sue Cocker Spaniel Rescue Australia, its officers and volunteers from time to time, for any personal injury or property damage sustained by me or any other person arising out of or in any way associated with the fostering of the dog including any action to recover damages or fines for which I am liable at law and/or under this agreement.

We appreciate you taking the time to complete this application. Upon review and approval, we will contact you.

CSRA reserves the right to refuse any application without prejudice or explanation

Signed (Applicants name printed)