Foster Application Form

COCKER SPANIEL RESCUE AUSTRALIA (under the umbrella of English Cocker Spaniels Australia Incorporated) ABN: 57 202 992 447, Registered Charity with the ACNC, CCP 3163 Postal Address:: PO Box 293 GLENSIDE SA 5065 www.csra.org.au https://www.facebook.com/CockerSpanielRescueAustralia/

Cocker Foster Application Form

Please provide answers to all questions, failure to do so may result in your application being rejected.All applications will be acknowledged via text & email, please ensure that you check your Spam/Junk folderRescue dogs come into our care from all different types of backgrounds, and some are not pretty. Foster carers help to turn the life of a dog around and it can take time and effort to do so. It can mean trips back and forth to the veterinary clinic, administering medications daily, grooming, toilet training, and usually lots of general training. It can be frustrating and sad, but it can also bring a lot of joy and be very rewarding. But fostering is not for everyone, and it is certainly not a shortcut to obtaining a Cocker Spaniel. Before you progress and complete this application form, you need to consider if fostering is truly for you (and the whole family), as all the family must all be on board with the care and training of the dog.

Personal Details:

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?

If you do not have children living at your premises, but do have children that visit you (i.e. grandchildren, nieces/nephews, friends), could you please advise their ages.

*How old are the children that visit you?:

WHAT TYPE OF PROPERTY DO YOU LIVE IN?*

House (single storey)

House (two storey)

Apartment − if multiple floors, please state which floor you’re located on. If you have a balcony, is it secure and safe for a dog?

Unit (single storey)

DO YOU OWN OR RENT YOUR PROPERTY?

Own

Rent

If renting the property, please supply the contact details for your Property Manager/Landlord (this includes their name, the name of the Real Estate Agency (if applicable), an email address and a mobile telephone number/landline telephone number). It is not sufficient to say you have permission, we must make contact with them to ensure that you do have permission and that it is noted on your lease/tenancy agreement.

Name of Property Manager:

Mobile Number:

Real Estate Agency:

Email address:

Outside Area:

Do you have a fenced backyard?

Is it secure?

Approximately what size is it?

What is the height of your fencing at its lowest point (approximately)?

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.

Please tell us why you want to be a foster carer?

Have you owned Cocker Spaniels previously?

Yes

If not, have you undertaken any research on the breed?

Yes

Do you currently have any pets in your household? (If so, please list their type, sex, and age)

Do any of your current pets have any behavioural or socialisation problems? If so, please explain.

Are all of your dogs/cats desexed, microchipped and registered with your local Council/Shire?

Yes

If no, please give reasons why.

Are all your current dogs/cats in your household up to date with their vaccinations?

Yes

If not, please explain why (i.e. dog has autoimmune disease and cannot be vaccinated)

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

Yes

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

Yes

Are you willing to foster a dog who is not a Cocker Spaniel, if required?

Yes

Will the Cocker Spaniel be an inside or outside dog? Please note: CSRA does not allow fosters to outside only homes.

Where would the Cocker Spaniel be sleeping?

What are your working circumstances? How long would the Cocker Spaniel be alone each day?

Do you have a doggy door installed in your home?

Yes

What would you do if the Cocker Spaniel developed behavioural issues?

Have you ever been a foster carer with any other rescue groups or shelters?

Yes

REFERENCES

If you currently have a veterinary clinic that you attend, could you please provide the contact details (this must include the name of the veterinary surgery/clinic/hospital, their telephone number and an email address). Please make contact with your current veterinary clinic and advise them that you have submitted a foster form to CSRA and that CSRA will be in contact with them for a reference (ask if they could note it on your records, please). If the veterinary records for your pet are NOT in your name, or if you haven’t been to your veterinarian in 3 or more years, please do not provide their details. Remember we will be seeking a reference about YOU, as a pet owner, not the health status of your pet.

Name of your current Veterinary Clinic/Surgery/Hospital:

Telephone Number:

Email address:

A reference from your current veterinary clinic is much preferred, however if you do not have a current veterinarian that you see, please provide the name of a person (a personal referee) who knows you extremely well, and has visited you at your residence and can vouch for you as a suitable person to be a foster carer with Cocker Spaniel Rescue Australia. Contact details must include their name, mobile telephone number and their email address. Please ensure that you have made contact with them to seek their approval to act as a personal referee for you.

Name of personal referee:

Mobile telephone number:

Email address:

IF YOU WERE TO BE SELECTED

Prior to you taking the Cocker Spaniel home, you must confirm that you, and all the members of the family who currently live in the home, support your application to become a foster carer.

I confirm that all members of the family support my application to become a foster carer with CSRA

Yes

PLEASE REVIEW YOUR APPLICATION TO ENSURE THAT YOU HAVE ANSWERED EVERY QUESTION, FAILURE TO DO SO MAY RESULT IN YOUR APPLICATION BEING REJECTEDALL APPLICATIONS WILL BE ACKNOWLEDGED VIA TEXT & EMAIL, PLEASE ENSURE THAT YOU CHECK YOUR SPAM/JUNK FILE

THIS FORM CONSTITUTES A LEGAL AGREEMENT

Before you submit it, please read this very 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:

o I exercise effective control of the dog

o The dog does not wander at largeoThe dog is on a lead (not exceeding 2 metres in length) when in a public place

o 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

o The dog does not attack, harass or chase any person or any animal owned by or in the charge of another person

o The dog does not injure or damage the property of another person

o The dog does not create a noise by barking or otherwise which unreasonably interferes with the peace, comfort or convenience of a person

o 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)

o If the dog defecates in a public place I will immediately remove the faeces and dispose of them in a lawful and suitable manner

o 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.

Cocker Spaniel Rescue Australia (under the umbrella of English Cocker Spaniels Australia Inc) reserves the right to refuse any application without prejudice or explanation.

Your Signature

Date:

Cocker Spaniel Rescue Australia

Date:

Thanks for submitting!

OFFICE USE ONLY*

Identification sighted:

Questionnaire Completed:

Home Check Completed:

References Obtained: