Peke N Chin Midwest

Pekingese and Japanese Chin Rescue and Re-homing

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Volunteer Application

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Would you like to make a tax deductible donation to our General Medical Fund or to sponsor one of our dogs? Make sure you make a notation how the funds should be used, as a Buddy Donation, General Donation or to Sponsor a Pet - no amount is too small!

Please consider visting iGive.com. A portion of your purchase from major, upscale retail stores will then come back to PNC Midwest when you choose us as the recipient of this donation.

Another way to help donate to PNC Midwest is by downloading a search engine through GoodSearch.com Get started right now and download the GoodSearch toolbar!

Volunteer Application

This application form is intended to be a guide to help you consider ways you might want to assist our organization as a Volunteer. This is by no means meant to be a test that will be used to disqualify you from consideration for helping one of our pets. Please give some thought to each question below rather than automatically answering yes.

Please be aware: You must use TAB or your mouse to navigate through this form. If you use the spacebar or press ENTER, it will submit an incomplete application.

Area in which you are interested:

Are you a Volunteer with another organization?
Yes No
If yes, which one?

Have you adopted from us in the past?
Yes No
If yes, which one?

Do you have experience with rehabilitating unsocialized or puppy mill dogs?
Yes No
If yes, please explain:

Your name:
Email address:
Telephone:
Additional phone/fax:
Address:
City/State/Zip:
Your profession:
Your spouse's profession:

Number of pet(s) previously owned:

Age/breed when acquired:

What happened to this/these pets?

Number of pet(s) that you currently have:

Tell us about your current pets (gender/age/breed/age when acquired, etc.)

Tell us about its/their temperament:

Are they spayed/neutered? Yes No

Do you own or rent? Own Rent

Your home: House Apartment Other

Describe your home:

Do you have a securely fenced yard? (completely fenced without holes)
Yes No

Describe your yard/fence:

If you do not have a fenced yard, how do you plan to have the dog relieve itself?/exercise?

What percentage of time will your dog be in the following?
House: %
Yard: %
Other: %

How many hours a day are you away from home?

Where will your dog be during this time?

If you will be away for work or vacation, how will the dog be cared for?

On what occasions do you plan to use a crate and, if so, for how long?

Where will the dog sleep?

What type of training do you intend for this dog?

I am willing to accept a dog that is not housebroken:
Yes No Maybe

Please explain:

In many situations, even though the dog may have training, coming to a new home will disrupt that. How do you plan to housetrain this dog?

Please list family members and their ages:

Dogs and small children should be supervised at all times. I can provide supervision.
Yes No

There will be other children visiting. Their ages:

They will be present:
Often Most of the time Some of the time Never

Comments:

Do you know if these children ever been around a dog before?
Yes No

If there were any problems, please describe:

Do you have any experience with rescuing a homeless animal?
Yes No

If so, please describe:

Briefly share your reasons for wanting to volunteer for Peke N Chin Midwest:

Describe your personality:

Hobbies, dog-related or not:

Gender preference:
Male Female Doesn't matter

Please explain:

Age preferred:
Puppy Young Adult (1-3 yrs) Adult (4-7 yrs)
Senior (7+) Doesn't matter
Please note that we rarely get puppies and seldom dogs under 1 year of age.
Comments:

I understand that it is not always possible to determine the exact age of a rescue dog. I am willing to accept a dog that is presumed to be in the age bracket I have specified.
Yes No

I am willing to accept a dog that has treatable medical problems (such as eye drops, ear drops, allergy medicine, diabetes medicine, heart medicine, epilepsy medicine, heartworm treatment, or other medicines or treatments).
Yes No Maybe

Under the following conditions:

I understand that the dog I foster is the possession of Peke N Chin Midwest and I agree to follow their guidelines for its care.
Yes No

Please provide any additional comments or concerns at this time:

Electronic Signature:

Date:

References

(Please provide THREE, including your veterinarian and groomer if you have one. If you rent, you MUST include your landlord as a fourth reference. Other references may include a neighbor or anyone who owns a high maintenance breed who has knowledge of you with dogs. Only one reference may be a relative.)

Reference 1:
Name:
Full Address:
Phone Number:
Email Address (if known):

Reference 2:
Name:
Full Address:
Phone Number:
Email Address (if known):

Reference 3:
Name:
Full Address:
Phone Number:
Email Address (if known):

Reference 4: (Landlord info if necessary)
Name:
Full Address:
Phone Number:
Email Address (if known):

Veterinary Services:
Clinic's Name:
Veterinarian's Name:
Full Address:
Phone Number:
Email Address (if known):

Have you ever used a groomer before? Yes No

Groomer's Name:
Full Address:
Phone Number:
Email Address (if known):

I have done dog grooming on other dogs: Yes No

I understand that some dogs require regular, routine grooming, regardless of whether the coat is left long or is in a puppy cut. I will able to do the following:

Daily brushing: Yes No
Monthly baths: Yes No
Nail trimming: Yes No
Ear cleaning: Yes No
Coat trimming: Yes No

I will take my dog to the groomer every weeks if I can't do these things myself.

Is there anything else you would like to add?

Please Note

Filling out this application does not in any way commit you to providing foster care, transport assistance, etc. This is to help us find an area you would be comfortable in. We work very hard with our Volunteers to help them find the right fit with their time contraints, family lifestyle, work schedules, etc. If you are a first time Foster Volunteer, we will do our very best to find the fit for you and are always available to you for assistance. We want this to be a rewarding experience for everyone involved.

Our sole purpose is to represent our breeds and "speak for the animals". That's just what we do.

Thank you for filling out this questionnaire. If there are any facts that you feel we should know about concerning your desire to volunteer, please be sure and include them in the additional comments section.

If you have further inquiries, please call Regina Goodhall at 218-681-7405 (home) or 218-686-3279 (cell). I will call you back collect as our funds are limited and reserved for the dogs.

Call me back collect:
Yes No

How did you find out about us?
Petfinder 1-800-Save-A-Pet Pets911 Kijiji Google Friend or Relative If other, please explain:

You many want to print a copy of this application prior to submitting (or clearing). If you have any questions, or problems, please email Regi Goodhall.

For office use only

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