Personal Information
Name:    Age:

Spouse/Partner: Age:

Address:

City: State: Connecticut Maine Massachusetts New Hampshire New Jersey New York Rhode Island Vermont

ZIP:

NERR&R places dogs in foster care in New England, parts of downstate NY, and NJ north of I-80. If you are outside of this area, please speak with a rescue group in your area.

E-Mail Address: (example: jsmith@aol.com)
Is this a home or work email address: Home

Please Note: Our first form of contact is by e-mail, if you prefer to be contacted by U.S. Mail, please indicate this in the additional comment box.

Home Phone:

Will you accept a collect call from us? Yes No

What is the best time to reach you? 

Your employer:
Phone:

Partner's employer:
Phone:

Children Living in Your Home:
	Number:	none 1 2 3 3 or more
	Sex: Age: Child 1 (youngest): Female Male Under 12 months 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years or over Child 2 (next youngest): Female Male Under 12 months 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years or over Child 3 (next youngest): Female Male Under 12 months 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years or over More than 3 children? Please list in the additional comment box below. What breeds of dogs have the children lived with? Is everyone in your household in agreement on fostering a Rottweiler?: Yes No If no, who is not? and why?: How long have you lived at this address? Please indicate which best describes your current living situation: -- Please choose one -- House Apartment Condo Trailer Other Do you: -- Please choose one -- Rent Own Live with parents If you rent, name & phone number of Landlord (your application cannot be processed without this information): If you live in a mobile home, name & phone number of land owner What type of environment? City Suburban Country If less than two years, please list your previous address: Besides your immediate family, are there others residing in your home? Yes No Names Ages: Does your home have a yard? Is there a fence? What type of fence and how tall? Will gate be locked with a padlock? Is the fence secured underground as well? If no fence, please indicate how you will exercise your dog (choose as many as apply): Invisible fence Cable runners Outdoor kennel Leash walk If no, where will the dog stay while you are gone? Where will your dog be kept most of the time? In house Outside Basement Other: (specify) If kept outside, will you have a dog house? Foster Information Is someone home during the day? Yes No If not, where will the dog stay while you are gone? If kept outside, will you have a dog run/dog house? (Dogs are not to be chained or tied out and left at any time) Have you ever owned a Rottweiler? Yes No Where is that Rottweiler now? Why have you chosen the Rottweiler breed to foster? What about the Rottweiler breed makes you want to foster one? Have you fostered any animal in the past? Yes No What kind of animal? Have you fostered dogs in the past? Yes No What Breeds? Through which agency (name, phone number)? How long did you foster for them? Are you still fostering for them...if not, why? What are you willing to provide for a foster Rottweiler (food, shelter, training, activities)? Do you prefer a male or female Rottweiler? Male Female No Preference Age range? -------- Pup 0-5 mo. Teen 6mo-1yr. Adult 1-5 5+ Other criteria for dog you'd be willing to foster: Are you willing to foster a dog until a permanent home can be found or other arrangements made? Yes No If no, please provide maximum time frame: Are you willing to provide transportation to and from the vet, attend local events & Rottweiler Days, etc. as needed? Yes No Other Pet Information Pet Information Number: none 1 2 3 4 5 or more First Pet: Name: Sex: Unknown Female Male Age: years months Weight: pounds Type: Dog Cat Bird Rabbit Rodent Pig Reptile Insect Other Breed: Vaccinations: Unnecessary All are past due Some are current All are current Spay/Neuter: Yes No Date of Last Vet Visit (mm/dd/yy): Is this animal on Heartworm Preventative?: N/A Yes No What kind?  Second Pet:   Name: Sex: Unknown Female Male   Age: years months Weight: pounds Type: Dog Cat Bird Rabbit Rodent Pig Reptile Insect Other Breed:   Vaccinations: Unnecessary All are past due Some are current All are current Spay/Neuter: Yes No Date of Last Vet Visit (mm/dd/yy): Is this animal on Heartworm Preventative?: N/A Yes No What kind? Please list other pets currently residing in your home (name, type, age): Are you willing to pay for a heartworm test? Yes No Veterinarian's Name & Phone Number: Name of owner listed at vet office if different than applicant: List other pets you have owned in the past ten years and what happened to them: How did you hear about North East Rottweiler Rescue & Referral? ----------- Internet Search Referral from Vet Friend Newspaper Previous NERR adopter Local shelter or Humane society Other (list below) Other: List any Humane Societies, Organizations, Breed or Training Clubs you are associated with: We will attempt to provide you with an honest evaluation of temperament on any dog we have to place. Do you realized that often times the complete history of a Rottweiler may not be known and you may encounter some behavioral problems? Yes No Are you willing to work with us on correcting these problems? Yes No Please provide the following information for references: Name Phone Number Relationship to you Number of years known Reference 1: Reference 2: Reference 3: Space for additional comments: Please check all boxes below.  If any of the boxes are left unchecked, your application will NOT be processed. By checking this box I certify that the information provided on this form is true & correct. I understand that proper food and veterinarian care can be costly and I am financially and physically able to care for this animal. I understand that NERR&R, Inc. will attempt to present the dog for foster having already obtained all of its vaccinations and spay/neuter. I also understand that I will be reimbursed for any pre-approved medical expenses related to this dog. I also understand that I am responsible for any food, toys, and travel associated with fostering this dog, and that I will not be reimbursed for it. (NERR is a non-profit organization under section 501(c)(3)). I understand that I am a volunteer for NERR&R. I will provide my own automobile and health insurance, and hereby agree to not hold NERR&R, Inc. or any of its volunteers, associates or foster care providers liable for any physical, emotional or property damages that are a direct or indirect result of activities involved in the placement, transport, grooming, training or evaluating of Rottweilers in any way associated with NERR&R, Inc. This includes any and all activities I perform as a NERR&R, Inc. volunteer. By checking this box, I am indicating that this is a valid and legal substitution for my written signature on this legal document titled "North East Rottweiler Rescue Adoption Application". I have read NERR&R's policies and agree to act in accordance with these policies while I am representing NERR&R. I understand that I will be notified by the volunteer coordinator once I have been approved. 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