First Name*
Last Name*
Address
City
State/Province
Zip/Postal Code -
Email*
Home Phone
Work Phone x
Cell Phone
Text/Pager Email
In what type of home do you live* Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing Other
Do you own or rent your home* Choose one: Rent Own Other
If you rent, have you received the approval of your landlord to have an animal* Choose one: Yes No N/A
If you rent, please enter your landlord's name and phone number*
Is your yard fenced* Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced Other
Please describe your yard
How many people reside in your household*
What are the ages of the children in your home?*
Does anyone in the household have allergies?
Please describe the allergies
Who in the household will care for the pet*
How much time will the animal spend alone during the day*
Will this be your first pet?*
What pets did you previously own?
What happened to them?
What pets do you currently own?
If you currently own a dog, is it neutered/spayed?*
What is the breed, age and sex of your current dog?
Please tell us the name(s) of your current dog(s)
Veterinarian's Name and Phone Number **Please notify your vet practice that someone from Tristate will be calling them, and provide your authorization for the practice to talk to the screener.*
Why do you want to foster a Basset Hound?
What sex do you prefer?*
Where will your Basset Hound spend most of its time?*
Are you willing to use a crate to train your Basset?
Do you agree to return your foster Basset Hound to us when a new home is found?
Are you willing to provide us with important foster home reports?
How were you referred to Tri-State Basset Rescue?
Signature: (type in signature(s)
Date
Additional Info and/or Comments: *
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