First Name

Last Name

Title

Organization

Street Address

City

State/Province

Zip/Postal Code

Day Phone

Night Phone

Cell Phone

E-Mail

What type of housing do you live in? Apt/Condo
Townhouse
Single Family Home

Do you own or rent? Own
Rent

If you rent, does your landlord permit dogs? Yes
No
Not Sure

If you rent, is there a weight/size limit on allowable dogs? Yes
No
Not Sure

If yes, what is the weight/size limit?

Do you have stairs in your home? Yes
No

If yes, how many stairs?

Do you have a fenced in yard? Yes
No

If yes, please describe your fence:

If no, do you agree to keep the foster on a leash when outdoors? Yes
No

Are you willing to have one of our volunteers visit your home prior to fostering? Yes
No

Do you have a veterinarian? Yes
No

What pet name and last name are your current vet records under?

Why do you want to foster a Basset?

How do other family members feel about fostering a Basset?

Which family member will be the foster's primary caregiver?

How many hours per day will the foster be left alone?

Where will the foster be kept during the day?

Where will the foster be kept during the night?

Are you willing to take your foster to a veterinarian on our approved list? Yes
No

What is the brand name of the dog food you will be feeding your foster?

Have you ever owned a Basset? Yes
No

Have you ever adopted a dog from a rescue organization or shelter? Yes
No

Have you ever fostered for a rescue organization before? Yes
No

If yes, please explain:

Have you ever had to give up a dog? Yes
No

If yes, please explain:

Are you willing to foster a special needs or senior Basset? Yes
No

Are you willing to foster a Basset recovering from surgery and/or on medication? Yes
No

Are you willing to foster a Basset being treated for heartworms? Yes
No

Are you willing to foster more than one Basset at a time? Yes
No

Have you ever taken a dog to obedience training? Yes
No

Are you willing to house train your foster, if necessary? Yes
No

Are you willing to crate train your foster? Yes
No

Do you have an available crate for your foster? Yes
No

What size is your crate?

Are you available by e-mail on a daily basis? Yes
No

Do you have an answering machine that you check every day? Yes
No

Do you own a working digital camera? Yes
No