IMPS VOLUNTEER APPLICATION Contact Information Name: NOTE: Please include your last name - an incomplete questionnaire will delay your application. Street Address: City: State:     Zip Code: County: Home Phone Number with Area Code: Work Phone Number with Area Code: Cell Phone Number with Area Code: Preferred Contact Number: Home Phone Work Phone Cell Phone E-Mail Address: I am applying to: YES    NO --- Foster Miniature Pinschers YES    NO --- Assist with home checks for prospective adoptive homes YES    NO --- Check my local shelter and report (see on-line Guide to Evaluating Shelter Dogs) YES    NO --- Screen owner surrenders and report YES    NO --- Transport Miniature Pinschers If YES, which states can you cover: YES    NO --- Place spayed/neutered Miniature Pinschers with an approved contract YES    NO --- Assist in other ways If YES, list special skills and areas of interest (e.g. fundraising):   We believe that volunteering for another Miniature Pinscher Breed Rescue is a conflict of interest. Why do you want to  volunteer with IMPS? Household Information: Do you presently own any pets?   YES    NO If YES, list the name and kind for each pet (e.g. Ted - dog; Sai - cat; Skip - parrot): If you own dog(s) are they all spayed/neutered?    YES    NO If NO, why not: Are there children presently living in the house?    YES    NO If YES, What are their ages?    Where do you live:    House    Apartment    Other    Does your home have a yard with a fence?    YES    NO If YES, What type fence:    Chain Link    Wood    Other    How high is the fence?    Do you own your home:    YES    NO If NO, Do you have permission from your landlord to keep a dog?    YES    NO Name of landlord:       Landlord's Phone Number:   Fostering: Have you ever fostered a dog before?    YES    NO How many hours will the dog be alone during the day?    Where will you keep the dog while you are not home? Do you have a crate to keep the dog in?    YES    NO Is there a limit to the length of time you can keep the dog until it gets adopted?    YES    NO If YES, How long can you keep the dog?    Why is there a limit? Is it OK if an interested person comes to your home to look at the dog? YES    NO Are you willing to assume financial responsibility for the every day care of the dog? YES    NO Are you willing to take the dog to a vet for spay/neuter, microchipping, etc. (at IMPS expense) YES    NO Do you understand that all placements must be done through IMPS applications process?    YES    NO Do you understand that any minpin you foster as an IMPS volunteer is the sole property of IMPS and must be returned to IMPS if requested to do so?    YES    NO The dog shall reside at the Foster Family's address and may not be given to anyone else or placed in any other home or facility. If the dog cannot be kept by the Foster Family, said Family shall notify the Regional Coordinator or Directors of IMPS immediately. The dog may not be sold, abandoned, relinquished to a pound or shelter or another rescue group, transferred or given to any other person, persons, group, organization or institution. By pressing the "Submit this application" button at the bottom of the page, you attest that you have read the above disclaimer and agree to the terms therein. Home Placements: Are you willing/able to do preliminary homechecks and post adoption checks for dogs placed in your area? YES    NO Are you willing/able to provide telephone support on training and behavioral issues for dogs you place? YES    NO Limitations If Limited, please describe: All paperwork for placement homes (e.g., applications, contracts) must be forwarded to the IMPS Directors within five business days of completion. Are you able to ensure that this requirement is met? YES    NO Other Tasks to assist the dog owner or other IMPS volunteers: Would you be able to take a dog to a vet for treatment, spay/neuter, microchipping, etc. (at IMPS expense)? YES    NO Would you be able to meet with an interested person at a dog's location (e.g. owner's home)? YES    NO Would you be able to have an interested person meet a dog at your home? YES    NO References: Please provide us with a veterinary reference (Including phone number): NOTE: Due to the new federal laws regarding the privacy act, you will need to contact your vet immediately and give permission for IMPS to contact them regarding the status of your pets records. Please provide us with a personal reference (Including phone number): Additional Comments: ** NOTE: Please answer all questions. An incomplete questionnaire will delay your application.   Please do not submit this application unless you are of legal age in your state. IMPS thanks you for your application. Your application will be submitted to Petie at hoving@i-2000.com, and you should receive word via e-mail within 48 hours. Return to IMPS main page