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Basset and Beagle Rescue of the Heartland Foster Application

Who are you Name:
Address: City: State: Zipcode:
Phone (preferred): Type:
E-mail:
Employer Name:
Number of Children:   If you have children please type their name(s) and age(s) below


What's your place like I would allow someone from BBRH to do a home visit?   YesNo

Please mark which of the following best describes your current living situation
Ownership Lease
Rent
Own
Live with Friend(s)
Live with Parent(s)
Type House
Condo/Townhouse
Apartment
Military Housing
Other
Location City
Suburban
Country

If you Rent/Lease, please provide the following information for your landlord or property owner, who holds your rental/lease agreement.

Landlord/Property Owner Name:
Address: City: State: Zipcode:
Phone:
How long have you lived at this address? (years) (months)
Besides your immediate family, are there others residing in your hosue?   YesNo
  If yes, relationship and name
 

What will life be like for your furry guest Does your home have a yard?   YesNo
If yes, is it fenced?   YesNo
  Fence Type: Fence Height:

Is someone home during the day?   YesNo
  If no, where will the dog stay while you are gone?
  How many hours will the dog be alone during the day?

Where will your dog be kept most of the time?   Inside Outside Basement Other
Do you have any other pets?   YesNo   If Yes...

Name Type (dog, cat, etc.) Age Current on Vaccinations Neutered/Spayed

YesNo YesNo


YesNo YesNo


YesNo YesNo


YesNo YesNo


  If you checked no to either question above, please provide details here
 
Are your animals on heartworm preventative?   Yes No   Type:

Have you ever had a neighborhood complaint filed with animal control? Yes No
  If yes, please explain
 

Your Veterinarian's Info Name:
City: State: Zip:
Phone:
If applicable, approximate date of your current pet's last office visit:
Have you ever had to give a dog up?   YesNo
  If yes, what was the circumstance?
 

If you have owned other dogs and do not now, what happened to them?


Pup Preferences What sex do you prefer?   Male Female No Preference
Preferred Age range?
Which breed do you prefer?   Basset Hound Beagle

Have you ever owned a Basset Hound or Beagle?   YesNo
  If yes, tell us about your Basset Hound or Beagle
 

Experience List any Humane Societies, Organizations, Breed or Training Clubs you are associated with

How many years have you been involved with dogs?  
List dog breeds you have had experience with and types of experience (training, showing, breeding, family pet, etc.)

Have you fostered dogs for another rescue group? Describe.   YesNo
  If yes, describe
 
Do you have confinement to isolate a dog for health reasons?   YesNo
  If yes, describe
 

Will you foster a dog with kennel cough?YesNo
Will you foster a dog that is injured?YesNo
Will you foster puppies?YesNo
Will you foster a dog that has behavior problems?YesNo
Will you foster a dog that is dog aggressive?YesNo
Will you foster a dog that is not housebroken?YesNo

Do you have special skills (trainer, vet, groomer, behaviorist, etc.)?


Fostering a dog may put you over the county pet limit, be aware of current county regulations.

References Please include address, phone number and how long known

Name Address Phone Known for (years/months)





Additional Comments

I certify that the information provided on this form is true and correct, to the best of my knowledge. I am also financially and physically able to care for this animal. I understand that proper food and veterinarian care can be costly and I am able and willing to meet these requirements. All medical expenses approved by the BBRH board will be reimbursed.

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