Your Last Name
Name and Age of each Adult in Household
Address City State Zip
Phone: (H) (W) Email:
1. In what type of housing do you live? Apt./Condo Townhouse Single Family
2. Do you own Rent? If you rent, does your landlord permit dogs? yes no not sure.
Is there a size/weight limitation on allowable dogs? yes no
If renting: Landlord’s name Phone
3. Do you have a fenced-in yard? yes no not sure.
Description of yard:
4. Number in household: adults Children. Ages of children:
5. Does anyone in the household have allergies? yes no
If Yes, describe:
6. Which family member will have major responsibility of caring for the dog?
7. How many hours a day would the dog normally be left alone?
8. How close is your nearest neighbor?
9. Will this be your first pet? yes no What pets did you previously own?
What happened to them?
What pets do you currently own? cats dogs birds other.
If you currently own a dog, is it neutered/spayed? yes no - What breed Age Sex
10. Who is your veterinarian? Name Phone
What pet name & last name are your vet records under?
11. Why do you want to foster a Basset Hound?
12. What sex do you prefer? male female Age preference
Note: Our fostering needs will in most cases determine age and sex of your foster Basset
13. Where will your Basset Hound spend most of its time?
15. Are you willing to use a crate to train your foster? yes no
16. Do you agree to return your foster Basset Hound to us when a new home is found? yes no
17. Are you willing to provide us with important foster home reports? yes no
18. How were you referred to Tri-State BH Rescue?
Signature: (type in signature(s)
Date:
Additional Info and/or Comments: