1.

First Name:

2.

Last Name:

3.

Street Address:

4.

City:

5.

State:

Select One Alabama Alaska Arizona Arkansas California Colorada Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

6.

ZIP Code:

7.

E-mail Address (name@host.com)

8.

Day Phone:

-

9.

Evening Phone:

-

10.

Best time to reach you:

1 2 3 4 5 6 7 8 9 10 11 12 AM PM

11.

What type of housing do you live in?

Apt/Condo
Townhouse
Single Family Home

12.

Do you own or rent?

Own Rent

12a.

If you rent, does your landlord permit dogs?

Yes No Not sure

12b.

If you rent, is there a weight/size limit on allowable dogs?

Yes No

12c.

If yes, what is it?

13.

Do you have a fenced-in yard?

Yes No

13a.

If yes, briefly describe it:

13b.

If no, do you agree to keep the dog on a leash when outdoors?

Yes No

14.

Have you ever owned a dog before?

Yes No

14a

Breeds

15.

Have you ever owned a basset before?

Yes No

16.

Why do you want to foster a Basset?

17.

What pets do you currently own?

Dog
Cat
Bird
Other

17a.

How long have you had this animal?

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Weeks Months Years

17b

If you currently own a dog, is is neutered/spayed?

Yes No

18.

Makeup of household:

Adults Children

18a.

Ages of children:

19.

Anyone in household have allergies?

Yes No

20.

Which family member will be the basset's primary caregiver?

21.

How many hours per day will the basset be left alone?

22.

How do other family members feel about fostering a basset?

23.

Are you willing to houstrain the dog if necessary?

Yes No

24.

Where will the dog be kept during the day?

24a.

Where will the dog be kept at night?

25.

Have you ever crate trained a dog?

Yes No

25a.

Do you have an available crate for your foster?

Yes No

25b.

What size is your crate?

26.

Do you have a veterinarian?

Yes No

26a.

If yes, what is the Vet's name and phone number?

26b.

What pet name and last name are your current vet records under?

26c.

If no, please give the name and number of local animal shelter or Humane Society.

27.

Are you willing to take your foster to a veterinarian on GABR's approved list?

Yes No

28.

Are you willing to have someone from GABR visit your home prior to fostering?

Yes No

29.

Are you willing to foster a special need or senior hound?

Yes No

29a.

Are you willing to foster a dog recovering from surgery and/or on medication?

Yes No

30.

Are you willing to foster more than 1 dog at a time?

Yes No

31.

Will you be able to provide your foster with quality brand dog food?

Yes No

32.

Have you ever given up a dog before?

Yes No

32a.

If so, why?

33.

Have you ever owned or fostered a rescue dog before?

Yes No