All Fields are REQUIRED

Date of Application

PERSONAL INFORMATION

Your Name (First & Last): * Your Age: * Street Address: * City: * State: * Zipcode: * Home Phone: * Cell Phone: * Email Address: * Best Time to Reach Me is: Best Method to Reach Me is: Select Best Method to Reach You Call Me on my Cell Phone Call Me on my Home Phone Text Me

I am interested in Volunteering in the following areas:

(Please select all that applies)

Yes

No

Foster Care: Yes or No?

Transport: Yes or No?

(Driving your car to pick up a rescued dog and take him to his new foster home)

Foster Support: Yes or No?

(Taking dog to the vet or groomer, short term fostering, etc.) You need to be available during

the day.

Graphic Design: Yes or No?

Making up flyers/posters

Other: Yes or No?

Please complete the section below in regards to your talents and education.

I have talents and education that would be useful in the following areas: * I would like to volunteer with Shih Tzu Rescue of Minnesota because: * Please share any other information with us that would help us to know you as a volunteer.

If you would like to volunteer for Foster Care, please fill out the following:

Please Note: Fostering a dog is a commitment that will require extra time from you....sticking with the

dog until he/she is adopted. It will require patience and diligence in the dog’s vetting, rehabilitation &

training. STRMN will pay for food, vetting, and provide you with a harness and leash for the dog; we also

have other dog supplies like gates and beds if you need it; but we cannot at this time pay for any

transportation/gas costs incurred. We will also ask you to bring the dog to our PetCo Meet and Greet once

a month. We will also ask you to be available for a Foster Home Orientation class and more advanced

trainings throughout the year. Before you say “yes” to take a foster dog, please consider these things.

You are never obligated to take a dog if you feel you cannot follow through with him/her.

Type of Dwelling: * Please Select One House Condo / Townhome Mobile Home Apartment Other If Other, please describe Do you Own or Rent? * Please Select One Own Rent

If you live in a rental unit, we will need a letter from your landlord granting authority to foster a

rescued dog on the property.

Do you have a fenced yard? * Please Select One Yes No If Yes, what type of fence? Please Select One Block Wall Privacy Wood Wood Picket Chain Link Invisible Other If Other, please describe Are you physically able to walk/exercise a dog 2 times a day? * Please Select One Yes No Can you commit to doing so? * Please Select One Yes No Do you have a space in your home to quarantine a foster dog if necessary? * Please Select One Yes No Are you a smoker? * Please Select One Yes No Yes, but NOT in the house OR car with pet

(This breed has very short nasal passages, and because of this can be prone to respiratory and

allergy issues. STRMN does NOT allow fostering in homes with smokers. The dog’s future

health is our priority.)

Who lives in your home? *

(including yourself)

What the are ages of each person in your home? *

(including yourself)

How many hours would your dog be left alone each day? * Where will your dog be kept during the hours he/she is left alone? * If necessary, would you be able to come home after 4 hours to left the dog out to relieve itself, or make arrangements for someone else to do so? * Select One Yes No

HISTORY OF PET OWNERSHIP

Do you currently own any pets? * Select One Yes No

If no current PETS click HERE to skip to the next question.

If Yes, please provide us with the following information about each pet:

CURRENT PET #1

Current Pet 1 Species Current Pet 1 Breed: Current Pet 1 Gender: Select One Male Female Current Pet 1 Spayed/Neutered: Select One Yes No Current Pet 1 Age:

FINISHED WITH OTHER PETS.

SKIP TO NEXT QUESTION.

CURRENT PET #2

Current Pet 2 Species Current Pet 2 Breed: Current Pet 2 Gender: Select One Male Female Current Pet 2 Spayed/Neutered: Select One Yes No Current Pet 2 Age:

FINISHED WITH OTHER PETS.

SKIP TO NEXT QUESTION.

CURRENT PET #3

Current Pet 3 Species Current Pet 3 Breed: Current Pet 3 Gender: Select One Male Female Current Pet 3 Spayed/Neutered: Select One Yes No Current Pet 3 Age: Have you owned any Dogs in the past? * Select One Yes No

If no current PAST DOGS click HERE to skip to the next section.

If Yes, please provide us with the following information about each pet:

PAST DOG #1

Past Dog 1 Name: Past Dog 1 Breed: Past Dog 1 Gender: Select One Male Female Past Dog 1 Spayed/Neutered: Select One Yes No Past Dog 1 Age at time of death or relinquished: Past Dog 1 How Many Years Owned: Past Dog 1 What Happened to this dog?

FINISHED WITH PAST DOGS.

SKIP TO NEXT SECTION.

PAST DOG #2

Past Dog 2 Name: Past Dog 2 Breed: Past Dog 2 Gender: Select One Male Female Past Dog 2 Spayed/Neutered: Select One Yes No Past Dog 2 Age at time of death or relinquished: Past Dog 2 How Many Years Owned: Past Dog 2 What Happened to this dog?

FINISHED WITH PAST DOGS.

SKIP TO NEXT SECTION.

PAST DOG #3

Past Dog 3 Name: Past Dog 3 Breed: Past Dog 3 Gender: Select One Male Female Past Dog 3 Spayed/Neutered: Select One Yes No Past Dog 3 Age at time of death or relinquished: Past Dog 3 How Many Years Owned: Past Dog 3 What Happened to this dog?

If you have, or have had, more than 3 current or past dogs/pets, please use the comment box at the

bottom of this application to provided detailed information about the rest of your pets.

PREFERENCES

Please let us know about the types of dogs you would like to foster: Please consider the time factor,

exercise factor, and your experience with dogs.  We don't want you to have any "surprises".

(Check all that applies)

Yes

No

Maybe, would like more info.

Dogs with special medical needs: Yes or No?

(We offer support)

Dogs with behavior needs: Yes or No?

(We offer support and professional training help)

Senior Dogs (ages 10 or over): Yes or No?

Adult Dogs (over 3 years old): Yes or No?

Young Dogs (under 3 years old): Yes or No?

Puppies (12 weeks and under): Yes or No?

Do you have a gender preference? Select One No Preference Yes - Female Yes - Male How often would you like to foster a dog for rescue during the year? (there is no wrong answer) Select One Once 2 to 3 times per year As often as needed Are you familiar with the grooming, dietary and medical needs of a Shih Tzu? Select One Yes Need more education Is there any other information you would like to share with us about your desire to foster, or the type of Shih Tzu you would like to foster?

REFERENCES:

Please provide THREE references, to including your Veterinarian if you have one. Only 1 relative may be used.  Please contact your references to let them know they may be called.

Veterinarian / Clinic:

Vet or Clinic Name: Vet or Clinic Address: Vet or Clinic City, State, Zip: Vet or Clinic Phone Number: Best Time to Call Vet:

Groomer:

Groomer Name: Groomer Address: Groomer City, State, Zip: Groomer Phone Number: Best Time to Call Groomer:

Reference #1:

Reference 1 Name: Reference 1 Address: Reference 1 City, State, Zip: Reference 1 Phone Number: How does Reference 1 know you? Best Time to Call Reference 1:

Reference #2:

Reference 2 Name: Reference 2 Address: Reference 2 City, State, Zip: Reference 2 Phone Number: How does Reference 2 know you? Best Time to Call Reference 2:

Shih Tzu Rescue of Minnesota Confidentiality Agreement

The volunteer acknowledges that he/she may gain access to Shih Tzu Rescue of Minnesota’s confidential

and proprietary information, including, without limitation, mailing lists, personal information related to

home addresses and telephone numbers of other volunteers and supporters of Shih Tzu Rescue of

Minnesota, information regarding Shih Tzu Rescue of Minnesota’s relationship with shelters, and its

policies and procedures.  By agreeing to be a volunteer for Shih Tzu Rescue of Minnesota, the volunteer

agrees that he/she will not at any time disclose confidential information to any person or entity who is

not an active Shih Tzu Rescue of Minnesota volunteer.  The volunteer agrees that this confidentiality

provision shall survive regardless of whether or not the volunteer ceases his/her participation in and

support of Shih Tzu Rescue of Minnesota.

Type your name >

has read the above Shih Tzu Rescue of Minnesota

Volunteer Guidelines and agrees to comply with them.

Release and Hold Harmless

I fully understand and agree to assume all risks involved in any and all activities, tasks or duties that I

perform for Shih Tzu Rescue of Minnesota in my volunteer capacity.  I also understand that the behavior

of domestic animals may be unpredictable.  Knowing the risk of handling domestic animals, I agree to

assume those risks and to release, discharge and hold harmless Shih Tzu Rescue of Minnesota, its

volunteers, agents, officers and directors, and its or their successors, from any and all liability, claims and

damages arising out of or as a consequence of, any injury or damages that may result to me or members

of my household from any activity connected with volunteer activities for Shih Tzu Rescue of Minnesota.

(Check Here) I agree to the above terms

To help reduce Spam, please enter the TYPE of animal in the picture above

By submitting this form to STRMN, this constitutes your electronic signature hereon.

STRMN may also require that you submit an original signature via U.S. Mail Service.

Volunteer Application

Thank you for your interest in our organization. 

Shih Tzu Rescue of Minnesota is a group of dedicated volunteers committed to the rescue, fostering and rehoming of Shih Tzus and Shih Tzu mixes.  We believe it is important for the members of our group to be friendly, respectful and supportive of all the volunteers in our group. 

We work cooperatively with the members of our own group as well as other rescue/shelter groups.  As a volunteer, you will be helping to save the lives of the dogs we rescue and also sharing our mission with the public.

Please note that fostering a dog is a commitment that will require extra time from
you....sticking with the dog until he/she is adopted.  It will cost you very little, if any, money,
but does require patience and diligence in the dog’s rehabilitation/training. 

Please fill out the application below so we can know more about you and your volunteer interests.
Thank you!

If you are unable to submit this form, you can also download this
form in Word or PDF Format.