Name:

Address:

City:

State:

Zip:

Day Phone:

Eve. Phone:

EMAIL:

Best time to call?

GSPCA Membership Number:

How long have you been involved with German Shorthaired Pointers?

Other Breeds? (please list)

Experience with breed (activities, training, etc.)?

Regular veterinarian and/or clinic:

Address:

Phone:

Breed & all breed club memberships:

How many GSPs do you own?

   Age(s): 

Gender(s)

   Male     Female  Neutered?  Yes  No 

Other companion animals?

Are you willing & able to foster needy GSPs?

Yes    No  How many?    M/F 

For how long?

Would you be able to keep a foster GSP inside, house- and crate-train?

Yes  No

Any comments:

Containment you can provide: Kennel Runs

Yes  No   Sizes    Heights 

Crates

Yes  No  Sizes    Types 

Fenced Yard?

Yes  No   Size 

Type Fence

  Fence Height 

Other services you could provide instead of or along with being a foster home

Transportation?

Yes  No    How Far? 

Provide funding for an ad

Yes  No

Funding for vet care

Yes  No

Offer counseling

Yes  No

Offer training

Yes  No

Type of training?

Screen Adopters?  Yes  No

Follow-up home visits

Yes  No

Transport to and from vet`s office

Yes  No

Visit shelters, pounds & private homes to identify dogs as purebred GSPs

Yes  No

Provide food for 1 or more dogs

Yes  No

Fund raise

Yes  No

Assist with fundraising events

Yes  No

Help with phone chain

Yes  No

Help with clerical duties

Yes  No

Regional rescue

Yes  No

National rescue

Yes  No

Visit dogs at shelters, etc. to provide socialization and modest training

Yes  No

Any other help you could provide, comments:

Local club funds, adoption donations or local fundraising efforts will contribute to reimbursement. I will not bring suit against GSPCA, GSPCA National Rescue, its agents, and volunteers, their heirs or estates in case of financial or other loss resulting from my activities as a rescue volunteer.

Furthermore, I, the undersigned (please print), ___________________________, understand and agree to the following: ALL GSPs MUST be altered prior to placement
ALL GSPs MUST be up to date on all vaccinations prior to placement
ALL GSPs in our program are the property of GSPCA Nat. Rescue and must be placed with a contract
Any adopter has to meet the appropriate criteria for our breed.
I agree to keep proper records of all dogs in my care, and to provide copies for GSPCA Nat. Rescue
If for any reason, it is found that I am no longer able to provide proper foster care, I understand and agree to turn over any foster GSP to GSPCA Nat. Rescue and to, furthermore, return any property that belongs to GSPCA Nat. Rescue to them. This includes crates, leashes, collars, and any other items purchased by GSPCA Nat. Rescue.
I agree to have an initial home visit by a GSPCA Nat. Rescue representative (this may include a representative from another breed rescue organization) prior to fostering any GSP
I agree to allow future occasional home visits by a GSPCA Nat. Rescue representative
I give permission to GSPCA Nat. Rescue to call and confirm references listed here-in, i.e. Veterinarian.
I agree to stay in touch with GSPCA Nat. Rescue regarding any updates on dogs, adoptions, and any other rescue related issues
I agree to work together with other GSPCA Nat. Rescue volunteers and independent bona fide GSP Rescue organizations in my state and nationwide.
I agree to not export/import GSPs from other states w/o coordinating any such rescue effort with the GSPCA National Rescue Coordinator of that state.
I hereby verify that I have never been accused of and/or found guilty of any misconduct related to animals
I agree to represent GSPCA National Rescue, GSPCA, our breed and its best interest to the best of my ability
I agree that I will be responsible for any legal fees or other costs which GSPCA National Rescue or any local or regional GSP Rescue group must expend to enforce my compliance with the foregoing items or as a result of my provision of false information on this form

By entering your name below you agree to the above:

SIGNED:   DATE: