BellyRubs Basset Rescue
Foster Home Application

So that we may properly assess your capabilities, please answer the following questions as completely as possible. Please let us know about any special needs or questions you may have.

Thank you.

Your Street Address: _____________________________________________________________

City: State: Zip Code: _______________________________ , ____   ___________

Home Phone: __________________  Work Phone: __________________________

E-mail Address: ______________________________________

What are your typical work hours? ____________________________________________________

Do you own or rent your home? Own ___    Rent ___  

What type of dwelling is it? House ___   Condo ___  Apartment ___  Mobile home ___

Do you have a fenced area for the dog? Yes ___   No ___

If yes, type of area: Kennel ___   Yard ___

Type of fencing and approximate dimensions: ___________________________________________
______________________________________________________________________________

If not, what arrangements will you have for the basset's exercise and toilet duties? ________________
______________________________________________________________________________

Have you ever owned a dog before? Yes ___   No ___

If yes, what breed(s) have you owned? _________________________________________________
_______________________________________________________________________________

Have you ever owned a basset hound before? Yes ___   No ___

Do you presently own any other animals? Yes ___   No ___
If so, please list all animals in the home, including the sex, breed. _____________________________
_______________________________________________________________________________

Are any of your animals altered? Yes ___   No ___
How long you have you owned your other animals? ________________________________________
_______________________________________________________________________________

How many adults are in your household? ________________________________________________

How many children are in your household? _______________________________________________

What are the ages of your children? ____________________________________________________

How do other family members feel about fostering a basset? _________________________________
________________________________________________________________________________

Is anyone home during the day? Yes ___   No ___

Is anyone home at night? Yes ___   No ___

Is anyone in the home allergic to dogs? Yes ___   No ___

Where will the basset hound be kept during the day? _______________________________________

Where will the basset hound be kept at night? _____________________________________________

When you are away from home? _______________________________________________________

Are you established with a vet (as a reference)? Yes ___   No ___
If yes, please provide your vet's
Name: _____________________________________________
Address: ___________________________________________
City: State: Zip Code: ____________________ , ____ _________
And your vet's and phone number: _________________________

Personal references:
Names, addresses, phone #'s:
__________________________________  _____________________________  _____________
__________________________________  _____________________________  _____________
__________________________________  _____________________________  _____________

Are you willing to house train a basset hound, if necessary? Yes ___   No ___

Sometimes we have Special Needs basset hounds that may be harder to place.
Are you willing to foster a dog with any of the following traits? [mark all that apply]
senior dog [6+ years] ___   basset mix ___   basset with special medical needs ___

Do you agree to home visits from the BellyRubs Basset Rescue personnel, and phone calls to check on the welfare of the basset hound? Yes ___   No ___

Please let us know about any special needs or questions you may have. _______________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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All of the information I have provided on this application is to the best of my knowledge, true and complete. I understand that falsifying answers on this application, or at any other time during the approval process, disqualifies me from being a foster home.
 

____________________________________    ________________

Signature                                                                 date
 
 

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