Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Preferred contact method:

Home Phone

Mobile Phone

Email

Check all areas in which you would like to be involved: *

Transportation

Phone Calls

Fostering

Home Evaluations

Rehabilitation (medical or behavioral)

Waystation (one week max foster care)

Evaluations Of Shelter Dogs (In Person Evaluations)

Other

Can you provide foster care for an indefinite period?

Yes

No

Where do you currently live?

Rural

Urban

Suburban

Other

Do you rent or own?

Rent

Own

If you rent, do you authorize a member of ARCBCR ro contact your landlord to verify your information?

Yes

No

Do you have a fenced in yard?

Yes

No

Do you authorize a member of ARCBCR to visit your home and interview your family?

Yes

No

Have you or anyone in your household been convicted of animal cruelty, neglect, or abandomnet? *

Yes

No

In agreeing to the limited liability for voluneering with Atlantic Region Central Border Collie Rescue, Inc (ARCBCR), I release, discharge, and hold harmless ARCBCR, all individual volunteers, and anyone else associated with ARCBCR from any charges or claims arising from my participation in any action related to the activities of Atlantic Region Central Border Collie Rescue, Inc. *

Agree