Please provide us with the following contact information:

Your Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
FAX
E-mail

How did you hear about us?

Please answer the following questions as completely as possible.

How many members are in your household?

Ages of children living in your household?

Are all members of household in favor of becoming a foster family? 

Yes
No

Are you established with a veterinarian?

Yes
No

Please provide the following information about your veterinarian.

Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Phone

Have you ever owned a Basset Hound before?

Yes
No

If you have previously owned a basset, please tell us a little about him or her: 

Have you had or do you have any other pets?

Yes
No

If yes, what kind?

Are all of your pets up to date on their vaccinations?

Yes
No

Type of dwelling: Single Family Two Family Multi Family Apartment

Do you own or rent your home?

Own
Rent

If you rent, Please provide the following landlord contact information :

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Phone

Is your yard fenced in? (not a requirement)

Yes
No

Are you willing to have your entire family present for a home visit prior to fostering a rescued basset?

Yes
No

Are you familiar with the Basset breed?

Yes
No

Do you believe in crate training?

Yes
No

Do you understand that foster bassets are required to sleep indoors at night, and not allowed to roam loose outside in an unfenced area?

Yes
No

How often will the basset be left alone?
Daytime  Night time

While you are away, where will the basset hound be?

Briefly explain your interest in fostering a basset:

Do you agree to assume the responsibility of veterinary care for your foster basset? (Approved veterinary costs will be paid by ABC Basset Rescue, Inc)

Yes
No

Are you willing to take your Foster Basset outside multiple times a day to relieve him/herself, and for exercise? 

Yes
No

Do you agree to housebreak your foster dog if necessary?  

Yes
No

Do you promise to keep identification on the foster dog at all times?  

Yes
No

Do you agree to notify ABC Basset Rescue if your Foster dog is ever lost, seriously injured, or  stolen?  

Yes
No

Do you understand that while the basset is in foster care He/she remains the property of ABC Basset Rescue, and Can not be placed without the consent of an ABC representative?
  

Yes
No

In submitting this document, I acknowledge that I have fully answered the above listed questions honestly, and to the best of our ability. I understand that when we foster a dog, we are accepting the dog as is, and full responsibility for its actions while in our care.  No warranty or guarantee is either intended or given as to the physical condition or temperament of these foster dogs, as many times, their background is unknown. ABC Basset Rescue will make every effort to place the dog in a timely manner.   ABC Basset Hound rescue will not be responsible for any misrepresentation of the dog being placed in your home for temporary foster care.

I have read and understand this statement.