Representative Application

In order to maintain the best interest of the Yorkie Mannor, all Representatives (foster homes) or those involved directly with rescue must fill out an Application. Your Yorkie Mannor representative will be able to provide you an application, plus a Rescue Packet, which includes the Yorkie Mannor Policies & Procedures, and the required records to be maintained for individual dogs in rescue.

Name: _________________________________________________________________________________

Address: _______________________________________________________________________________

City: __________________________________________ State: _________________ Zip: _____________

Telephone: (Home) _________________________ (Work)______________________________

(Fax) ___________________________ (E-mail)_____________________________

Have you read Yorkie Mannor Rescue Policies & Procedures? ________________________________

Do you have any questions regarding our program? ____________________________________________

______________________________________________________________________________________

Do you own Yorkshire Terrier? ____________________ How many? _____________________________

How long have you had Yorkshire Terrier? ___________________________________________________

Are you a breeder of Yorkshire Terrier? _____________________ If so, what is the average number of Yorkshire Terrier litters bred per year? _____________________________ Do you support spay/neuter contracts for those non-show/pet quality puppies that you produce. _________ Do you support breeder/owner responsibility? __________

Do you breed and sell other breeds? ___________ If so, what is the average number of other litters bred per year? ____________________

clubs and/or all breed clubs to which you belong? ______________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________

Name of any Animal Organizations that you support: ___________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Have you worked (formally or informally) in rescue before? If so, please describe your experience: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

In which of the following areas are you willing to work?

Contact Person for Shelters: _____

Transportation: _______________

Foster Home (Long Term): _____

Foster Home (Short Term): _____

Correspondence: ______________

Name and telephone number (with area code) of your veterinarian: ________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Name and telephone number (with area code) of veterinarian you would use for rescues (if different from above): _______________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Names and telephone numbers of two Yorkshire Terrier fanciers for reference purposes:

_____________________________________ ______________________________________

_____________________________________ ______________________________________

I agree to abide by the Policies & Procedures of Yorkie Mannor. To maintain the Mission Statement of Yorkie Mannor and to abide by the Rules set forth by the Yorkie Mannor representatives. I hereby agree that any money (adoption or general donations) that I collect or receive for Yorkie Mannor will be turned over to the Yorkie Mannor Treasurer. Additionally, I hereby certify that I am in good standing with the American Kennel Club and that I am at least 18 years of age.

Signature: __________________________________________ Date: _____________________________

Thank you for your interest in helping with Yorkie Rescue. Your application will be considered and you will be notified.

Please return this application to Yorkie Mannor.  If unsure, go to the Members Page to find who your local Coordinator is and E-mail them with the application, or ask for address to send.  If you do not have a Coordinator in your area, contact the Rescue Liaison.