Registration

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Welcome, and thank you for your interest in becoming a rescue volunteer! (Please DO NOT register here if you are ONLY interested in adoption. Use the adoption application instead.) Please provide all information requested. Failure to do so will delay the processing of your registration and status as a rescue volunteer. Hold your mouse over the icons to the right of each field for tips. Thank you!

Name:

Email:

Username:

Password:

Verify Password:

IMPORTANT!:

PLEASE READ! There are three steps to our application process. Please complete ALL three steps.

This registration, below these instructions:
HRI Skills assessment (all volunteers must complete)
Signing and mailing the volunteer contract (all volunteers must sign and mail)

You will automatically be directed to each step in the process. If you skip any of the steps, your volunteer application processing will be delayed. It helps if you collect your reference(s) contact information ahead of time.

Street Address:

City:

State:

Zip Code:

Primary Phone:

Work Phone:

Secondary/Cell Phone:

Best Time to Call:

Best Contact Method:

Alternate Address:

Alternate Email Address:

Occupation:

Age:

State(s) I Can Assist:

References:

Please provide a list of 4 references, only one of which may be a relative, who are familiar with your home and pets. You must also provide a veterinary reference.

Ref 1 Name:

Ref 1 Relationship:

Ref 1 Phone:

Ref 2 Name:

Ref 2 Relationship:

Ref 2 Phone:

Ref 3 Name:

Ref 3 Relationship:

Ref 3 Phone:

Ref 4 Name:

Ref 4 Relationship:

Ref 4 Phone:

Veterinarian Name:

Vet Clinic Name:

Veterinary Address:

Vet City, State, Zip:

Vet Phone w/area code:

Explain if not regular vet:

I am interested in:

Volunteer Only Volunteer and Foster Short-Term Foster Only

Foster Care Term:

Dog Transport:

If you can provide transportation to a rescue dog(s) please indicate the days of the week, times, and how many dogs you can transport.

Dog Transport:

Household Info:

Please provide the names, ages and relationships of others who will be living in the household with the dog, starting with significant other. If none, type none.

Names of household members:

Ages of household members:

Relationships of Household Members:

Household Agreement:

If you plan to provide foster care, is everyone in the household interested in adopting or fostering a Havanese? If no, please explain.

Household Agreement:

Yes No

Fostering Reservations:

Home Visit Agreement:

Do you agree to allow a representative of Havanese Rescue Inc to visit your home by appointment?

Home Visit:

Yes No

Caregiver:

Who will be the primary caregiver for the adopted/foster dog?

Primary Caregiver:

Why Havanese?:

Is a Hav Mix OK?:

Preference for Male or Female?:

Housetraining:

Are you willing to work through any housetraining adjustments? Please explain.

Housetraining Plans:

Age Preference:

Do you have a preference regarding the age of the potential foster or adopted dog?

Age Preferred:

No preference Puppy only (1-12 months) Young dog (1-7 years) Middle age (8-12 years) Senior (12+ years)

Temperament:

Would you foster or adopt a dog with temperament issues? Please indicate any behavior you would NOT feel comfortable dealing with.

Temperament Issues:

Prior Adoptions:

Have you ever fostered or adopted a rescue dog before? If yes, please indicate if it was from a shelter, another rescue group, etc.

Prior Fosters/Adoptions:

Prior Experience:

Do you have any experience in working with dogs in the following areas?

Experience:

Housetraining Aggression Shyness Abused/neglected Puppymill dogs Physical handicaps (blind, deaf, etc.) Other: please explain

Experience:

Medications:

Are you willing to provide medical treatment to the dog? Check all that apply.

Medications:

Monthly Heartworm Medications

Monthly Flea & Tick Preventative

Daily meds, various

Injections (diabetes, etc.)

IV fluids (kidney disease, etc.)

Hours Alone:

Where will the dog spend it's days? It's nights? What are your work hours? How many hours per day, on average, will the dog be alone?

Days & Nites:

Work Hours:

Hours Alone:

Care in Absence?:

Residence Information:

Please describe the residence where the dog(s) will be living.

Dwelling Type:

Single Family Home Condo/Townhome Apartment Mobile Home

Do you own or rent?:

Own Rent

Permission:

If you rent, do you have the landlord's permission to keep a dog? Please explain

Landlord Permission:

Laws, Rules:

Have you verified that you will not be violating any local ordinances/association by-laws/tenancy rules, etc., related to the number or size of dogs you can have in your house if you foster or adopt a Havanese?

Legal Compliance:

Landlord Info:

Please provide contact information for your landlord, if applicable.

Landlord Contact:

Moving:

If you plan to move in the near future, please explain:

Moving Plans:

Fences:

Do you currently have a fenced yard? Please describe the type of fence and how high it is:

Fence Info:

Exercise:

If you indicated you do not have a fence, how do you plan to handle exercise and toilet duties? Please explain in detail:

Exercise:

Dog History:

Current Dogs:

Please list name, sex, age and breed for each dog you currently own.

Name, Sex, Age, Breed:

Spay, Neuter:

If any of your dogs are not spayed or neutered please explain why.

Not Spayed or Neutered?:

Lifestyle:

Do your dogs spend most of their time indoors or outdoors, and why?

Inside or Outside?:

Other:

If there is any other pertinent information we should know about your dogs, enter it here.

Other Dog Info:

Cat History:

Please explain how many cats you have owned in the past 10 years and what happened to them.

Cat History:

Number of Current Cats:

Indoor or Outdoor Cats:

Cats Interaction with Dogs:

Other Pets:

Do you currently own any pets other than cats or dogs? If yes, describe them and how they interact with dogs.

Other Pets:

Pet History:

If you have ever lost, surrendered to a shelter/rescue, placed in another home or given a pet away, please explain why.

Prior Pet Placement:

Pet Character:

Please describe any characteristics of your current pets that Havanese Rescue Inc should be aware of.

Other Characteristics:

Other Information:

Please provide any other information which you wish us to consider in evaluating your application.

Special Information:

Agreement:

We reserve the right to refuse or deny any application. By submitting this form, you attest that all the information contained in this application is complete and truthful. In addition, you expressly authorize Havanese Rescue Inc to verify the information on this application. Any misrepresentation will constitute grounds for automatic rejection.

Submittal Agreement:

Once you click Register, you will be taken to our skills assessment, after completing that, you will be redirected to a download page containing our contract. Please sign and return the contract via USPS mail so you can be approved as a volunteer. Thank you!

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