1.Applicant's Name:

2. Mailing Address:

3. Email address:

4. Phone Number Best Time to call:

5. Please list the names and ages of persons in your household:

6. Do you know any of the current members of MBCR? Who?

7. Veterinarian's Name, Address & Phone # (Required):

8. Personal reference:

For the safety of the dogs in the rescue, an investigation of the personal background of potential volunteers will be undertaken. This information will be held strictly confidential and is required for your protection as well as for that of the organization.

9. Tell us about your experience in living with dogs, working with dogs, training dogs, and showing dogs.

10. List types and ages of all household pets. (Please include sex, species, breed, spayed/neutered, etc.)

11. Please list your current and prior Animal Organization memberships and positions held: Foster Volunteers (Volunteers who are not interested in fostering dogs, please continue to item 17) :

12. How many, and what sex of dogs can you foster at one time?
Are there any preferences in type of dog placed with you?

13. Approximate Size of Yard:

14. Type of Fencing, height, and how much of yard is fenced?

15. Do you have a kennel run? What type and size?

16. What type and size crate(s) do you own?

17. Approximate time per day dog(s) would be left unattended: (All Volunteers)

18. In addition to fostering, there are many tasks which need to be done. Please select any/all activities with which you might be able to help:

Transporting Dogs to/between foster homes. How Far?

Conduct phone interviews of potential adopters?

Fundraising Activities. What kind?

Web site assistance

Comments:

By submitting this application to MidAmerica Border Collie Rescue, Inc., I agree to abide by the By-laws and Mission of MidAmerica Border Collie Rescue, Inc. and any policies and procedures developed by MBCR. Thank you for taking the time to complete this questionnaire. Yearly dues are required for voting membership in MBCR. If you wish only to volunteer (i.e., participate, but have no voting rights), no dues are required. Dues are currently $26.00 per year, or 50 cents per week, prorated from date of membership, and are renewable in January of each year. Please indicate whether you are applying for membership or to volunteer only.

Member Volunteer Only

Once we receive your application you will be contacted by a member of MBCR to discuss any questions. Your application will then be reviewed by our Board of Directors. If you have not heard from an MBCR member within one week of your submitting this application, please email Donna at dvenner@comcast.net