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Regular Membership

No Fostering

Welcome to our online membership form!

We’d love to add you to our BCCR family. Please note this application form must be completed in its entirety. Incomplete applications can not be processed. If you are having problems filling this out or reading our Code of Ethics (COE), please contact us for assistance.

What’s next after submitting this form? You should hear from us within 48 hours verifying we have received your application. Your application will then be looked at and sent to our management team for approval. You will be notified of your acceptance and sent a link to join our google chat list.

Remember, upon submitting this application, you are also accepting our Code of Ethics. Please make sure you read and understand them thoroughly.

Please write us if you have any questions. We look forward to having you as a member!

Step 1 of 5

20%

Today's Date
*
MM slash DD slash YYYY
Please provide the following contact information:
Name*
First Middle Initial Last
Spouse's Name

(if applicable)
Name of Employer

(if applicable)
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
E-mail address*
Home Phone*
Cell Phone
(optional)
Work Phone
(if applicable)

Is this a family membership?
- Yes
- No
- N/A
Your Age
(Note: If under 18 you must have a guardian's consent)
Age*
Please check what your interests are and tell us about your experiences? What areas would you like to help the BCCR in?
(check all that apply)
- Fundraising
- Membership & adoption interviews / homechecks
- Transport
- Mail outs / Phone
- Research / Marketing
- Website support or database maintenance
- Resource contact for shelters and/or other rescue organizations
- Public relations and advertising
- Add to email mailing list
- N/A - add to email mailing list only
- Other - please let us know below
Other comments or thoughts on helping the BCCR:
Can we contact you when we are in need of help?

Do you want to be notified of BCCR events?
- Yes
- No
- N/A
Do you support spaying and neutering of pets?
- Yes
- No
Do you have any pets?
*
- Yes
- No
Please provide breed, sex, age, and name of your dogs (and/or other pets):*
Are your pets up-to-date on their shots?
- Yes
- No
Please explain why your pets are not up-to-date on their shots
Are your pets spayed / neutered?
- Yes
- No
Please explain why your pets are not spayed / neutered?
Have you ever bred your pets?
- Yes
- No
Please explain why you bred your pets.

Have you had any previous pets?
*
- Yes
- No
What happened to your previous pets?
Name of Veterinarian
Veterinarian Name
First Last
Veterinarian's Title
Veterinarian's Organization
Veterinarian's Phone
Veterinarian's Website
Personal Reference 1
Name*
First Last
Relationship*
Home Phone*
Email
Personal Reference 2
Name*
First Last
Relationship*
Home Phone*
Email

What Humane Society or SPCA are you located near and do you have an established relationship with them?
Do you work with any other rescue groups or animal related organizations who we can contact for a reference?
If so, please list group(s) and contact information. Do we have permission to contact them?
Finally, please tell us why you would like to become a member of the BCCR?
Would you be open to fostering in the future? Feel free to share any additional thoughts with us here.
IMPORTANT INFORMATION - PLEASE READ
I, the undersigned, hereby certify that I am of legal age (older than 18) and that all statements made herein make full disclosure and are true. Should there be any change in the circumstances as stated above, I undertake to notify BCCR as soon as possible. I also understand that by submitting this application that I and the members of my household agree to the BCCR Code of Ethics. Download BCCR code of ethics.
I verify my understanding and acceptance of the above terms and conditions.
- Yes
- No
By submitting this form, you agree to all the above terms and conditions.
Phone
This field is for validation purposes and should be left unchanged.

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