Name (adults in household)

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Street Address

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City, State, Zipcode

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Home Phone

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Work Phone

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Cell Phone

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Place of Employment

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Occupation

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Email Address

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A successful foster home depends on both the selection of the right basset for your household and the understanding of his/her care taking needs. So that we may assist you with this selection please answer the following questions as completely as possible.

Type of Housing
HouseCondoApartmentMobile Home
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Do you rent or own?
RentOwn
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Do you have a fenced yard?
YesNo
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Are you a previous dog owner?
YesNo
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Do you own other animals?
YesNo
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List the type, breed, gender, age, spayed/neutered and length of ownership of other animals.

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Number of children in household

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How do other family members feel about fostering a basset?

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Have you read about basset hounds and dog ownership?
YesNo
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Is anyone home during the day?
YesNo
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Is anyone home at night?
YesNo
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Where will the dog be kept during the day?

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Where will the dog be kept at night?

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Where will the dog be kept when you are away from home?

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Is anyone in the house allergic to dogs?
YesNo
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If so, who?

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Are you willing to housetrain?
YesNo
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Are you willing to obedience train?
YesNo
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What vet will be taking care of your potential new foster family member?

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Vet Address

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Vet Phone Number

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All of the information that I have provided on this application is, to the best of my knowledge,
true and complete. I understand falsifying answers on this application, or at any other time
during the foster home process, disqualifies the household I represent from the fostering of a
dog from CBHR

I understand that submitting an application is no guarantee that I will receive a CBHR dog.
I further understand that placement of these dogs is at the sole discretion of CBHR and a
reason for rejection of an application is not required. Upon completion and submission of this
application and release of veterinary information I wish to be considered for fostering a CBHR
dog.

I also understand that if I do foster a dog from CBHR and should choose not to continue fostering the dog it must be returned to CBHR

I agree to the terms above
YesNo
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Release of Veterinary Information

I authorize any veterinarian or veterinary hospital/professional/kennel to furnish or discuss with any representative of CBHR all records in their possession regarding the care of the
applicants dogs past or present. This information will be used in the foster care process of one
of the dogs in care of CBHR. This authorization shall remain valid for one year after the date it
is submitted.

Upon presentation of this release of information or a photocopy of same, you are directed to
permit the personal review or discuss with a representative of CBHR the veterinary/kennel
records.

I agree to the veterinary release terms above
YesNo
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Additional Comments

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Enter code:


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