Membership Application

Name

First Last

Other Household Members

Home Phone

Cell Phone*

Office Phone

Please note that we are currently only accepting applications for residents of PA, NJ, DE, and MD.

Street Address*

Address Line 2

City*

State*

Zip Code*

County

Date of Birth

Primary Email*

Alternate Email

When is the best time to contact you?

Volunteer Areas - how would you like to help the rescue? Check all that apply:

Member Bio

Please tell us a little about yourself.

Profession

Special Skills

What special skills do you have that could support the rescue?

Affiliations

What other clubs or organizations are you a member of?

Siberian Experience

What is your experience with Siberian Huskies. Please also include the dogs you currently have.

Other Pets

What other pets do you have and/or have previously owned?

Age of children

What are the ages of the children in the household or the ages of family members that visit often?

Sponsors

Please tell us the member(s) who referred you to the rescue. Leave blank if not applicable.

For those interested in fostering for the rescue, the following questions must be completed:

Please select the most appropriate statement:

Are you interested in fostering?*

Yes

No

Reference #1*
You MUST provide two references of people that are NOT family. You MUST also provide the NAME, PHONE, E-MAIL and relationship of this person.

Reference #2*
You MUST provide two references of people that are NOT family. You MUST also provide the NAME, PHONE, E-MAIL and relationship of this person.

Other breed experience*
What other breeds of dogs do you have experience with? Tell us about the breeds you have owned in the past.

Current dogs*
List the breeds, ages, and sex of the dogs that currently live in your household and IF THEY ARE SPAYED/NEUTERED.

Other animals*
Please check the box beside each animal that currently resides on your property or in your home.
No other animals in the household
One cat
Multiple cats
Bird(s)
Rabitt(s)
Hamster, Gerbil, Guinea Pig(s)
Fish
Reptiles
Livestock - Cattle, Sheep, Goat
Livestock - Fowl

Other animal comments*
Please provide more information about your other pets or list additional species of pets here. If you have cats, tell us if they are indoor/outdoor or both and if they are able to be kept separate from the dogs. If you have birds, were are the cages kept? Anything that will help us to match the dog to your home.

Past pets*
Please list any other pets you may have owned in the past

Pets given up*
If you have ever given up a dog or other pet, please explain the circumstances here. If you have not given up a pet, please state that here.

Pets lost, stolen, or escaped*
Please tell us of any pets that have been lost, stolen or escaped. Include the species, breed, and circumstances.

Housing Status*

Rent

Own

Other

Pet Approval - if Renting*

Yes

No

If you rent, please provide the name and phone number of your landlord or rental agency:

Landlord/Rental Agency
Street Address Address Line 2 City State ZIP Code

Landlord's Phone*

Home Type*
Please describe the type of home you live in.

Years residing in your current home*

Yard Description*
Please select the most appropriate statement about your yard.

Does your yard have a pool?*

Yes

No

Fencing Description
Please check the boxes that describe your fence. For example, if you have a 4 Foot Chain Link fence, you should check off 4 foot and Chain Link / Cyclone.

3 foot high

4 foot high

5 foot high

6 foot high

Wood panel

Chain Line/Cyclone

Split Rail with Wire

Split Rail only

Kennel Run From Kit

Custom Kennel Run

PVC / Plastic Panel Fence

Iron / Aluminum Fence

Invisible Fence

Cable Run

Dog Tie Out

No fence exercise*
If you have no fence, how will you exercise the dog and manage potty detail? Put "n/a" if you have a fully fenced yard.

Number of adults*
How many adults (>18 Years) live in your household?

Number of children*
How many children live in your household?

Ages of children*
List the ages of the children living at home.

Children pet experience*
What experience do the children in the household have with pets?

Regular household visitors*
Infants and Toddlers
Children 5-10 years
Children 10-17 years
Adults
Other dogs
Other cats / pets

Veterinarian*
Please provide us with a name of a vet you currently use or have used in the past. If you are new to pet ownership, please provide the name of the vet you intend to use.

Vet Address*
Street Address Address Line 2 City State ZIP Code

Vet Phone*

Daily Containment*
How will your new Siberian Husky spend the day while you are out?

Other containment*
If needed, please provide additional information of how your dog will spend its time alone.

Home Alone*
How many hours will your new dog need to spend alone?

Bedtime*
In what manner will your dog be confined at bedtime?

Special consideration*
Are there any special considerations or needs that you would like to make DVSHR aware of?

Home Check Objection?*
Do you object to a home check? If so, please explain why.

Foster Preference
Please let us know if you would like to foster a dog and what type of scenario works best for you. For example, one dog, two dogs, short term (< 1-2 months), longer term, dog age, etc.

Foster Arrangement
If you are planning to foster a dog, please tell us about the environment the dog will live in. Include a brief description of your fencing, kennels, crating areas, alone time, who would be providing care, and so on.

Foster Limit
How many dogs could you foster at the same time?

VOLUNTEER AND FOSTER CARE WAIVER OF LIABILITY AGREEMENT

I have volunteered to be a member of Delaware Valley Siberian Husky Rescue (DVSHR), Inc. I understand that from time to time I may be called upon to transport, handle, place or provide foster care to dogs accepted into the rescue program. I understand that these dogs come from a variety of backgrounds, known or unknown, and may have temperaments, behavioral traits, or tendencies that are not known or knowable to Delaware Valley Siberian Husky Rescue, Inc., or its agents, officers, directors, or members. In accepting the care, custody or control of a dog in the program, I understand that I am relying on my own judgment and experience in transporting, handling, placing or fostering the dogs, and I am not relying on any representations made by the DVSHR, or its agents, directors, officers or members. I further understand that I am assuming the sole responsibility for my own safety when transporting, handling, placing or fostering dogs, and I agree to the following:

• The DVSHR has made no warranties or guarantees, express or implied, with regard to the physical condition of the dog, its background or its temperament or behavior.

• The DVSHR shall not be responsible for any and all damages, costs or expense incurred by the undersigned including, but not limited to, damage or injury to the volunteer or foster care provider’s person or property by the dog, or injury or damages to a member of the family of the volunteer or foster care provider. In this connection, the undersigned releases, discharges, and holds the DVSHR, its officers, directors, and member/volunteers harmless from any and all liability of any and every nature to the undersigned’s person or property, or to the person or property of family members, caused directly or indirectly by or from the handling, transport, care or fostering of dogs within the program. The undersigned further agrees not to sue DVSHR, its officers, directors, and member/volunteers, for damages for personal injury or property damage to the undersigned and to members of their family, whether caused in whole or in part by negligent conduct by DVSHR, its officers, directors and volunteer/members.

• All foster dogs are the property of the DVSHR until such time as they are adopted. Fosters, as with any approved applicant, have the option of adopting their foster dog(s). However, they must first make their intentions known to the foster chairperson for approval before processing any adoption.

• Fosters will need to update the Adoption Team email group with updates of their foster dogs on the 15th and the end of each month. This will allow members that are working with applicants to have the most up-to-date information on all available foster dogs. This also includes updating their web bios with new info, photos, etc.

• Fosters must post new dogs to the web dashboard within 24 hours of entering the program and have them placed up on the public portion of the site within 7 days thereafter. There may be special exceptions where the Board requests that the dog not be posted to the site.

• Fosters must be reasonable and keep an open mind when evaluating the suitability of a potential new home for their foster dog. Not every home will be perfect, but what needs to be realized is what is best for the foster dog.

• Dogs must be made available for meet and greets with potential adopters. Foster homes will also need to contact potential adopters to discuss their foster dogs. Fosters should also make every effort to bring their foster dogs to events attended by the DVSHR.

• Any aggressive behavior noted with a foster dog will need to be reported to the board immediately.

• The DVSHR retains the right to visit any foster dog with advance notice given to the foster home.

• Any one time expenditure that will exceed $250 will need to have prior board approval. This would most likely occur during a schedule vet visit, so fosters will need to obtain an estimate for vet services if they will exceed the $250 limit. In an emergency situation, fosters should make their best effort to contact at least one board officer (president, v. president, secretary, or treasurer). If a board officer cannot be reached and the situation is dire, the foster should proceed with obtaining the required vet care. However, a board officer will still need to be apprised of the situation via phone, email, fax, etc.

Signature*

How would you like to make your dues payment?*

Paypal

Via a check by mail

I was a Foster Family last year (dues not required)

I am Fostering with Intent to Adopt (dues waived)
Please mail your check to DVSHR Inc, P.O. Box 773, Horsham, PA 19044

Membership Level

Basic Membership - $25/yr

3 Year Membership - $60/yr

5 Year Membership - $100/yr
Receive a free DVSHR calendar with a 5 year membership!

Membership Level

Basic Membership - $25/yr

3 Year Membership - $60/yr

5 Year Membership - $100/yr

Total
$0.00

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Name
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DVSHR Membership Application