Adults in household

Children in home

Address

Please select state AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA DC WV WI WY

Telephone

Email

Employment

What type of housing do you have? House Townhouse Duplex Condo Apartment Modular Home Farm

Do you rent or own?
Rent
Own

If you rent or lease, do you have permission from your landlord to keep a basset indoors?
Yes
No

Landlord's Name

Contact Number

Do you have a fenced yard?
Yes
No

Are you a previous dog owner?
Yes
No

Do you own other animals?
Yes
No

Please list the name, type, breed, gender, age, spayed/neutered and length of ownership of other animals.

How do other family members feel about fostering a basset?

Have you read about basset hounds and dog ownership?
Yes
No

Is anyone home during the day?
Yes
No

Is anyone home at night?
Yes
No

Where will the basset be kept during the day?

Where will the basset be kept at night?

Where will the basset be kept when you're away from home?

Is anyone in the house allergic to dogs?
Yes
No

If so, who?

Are you willing to house train?
Yes
No

Are you willing to obedience train?
Yes
No

Reference Information

If you have owned a pet in the past two years, please provide veterinary name and contact information below.

Release of Veterinary Information

I authorize any veterinarian or veterinarian hospital/professional/kennel to furnish or discuss with any representative of CBHR all records in their possession regarding the care of their animals past or present. This information will be used in the adoption process of one or more dogs in the care of CBHR. I understand this authorization shall remain valid for one year after the date it is submitted. Upon presentation of this document, a photocopy or facsimile of same, you are directed to permit the personal review with a CBHR representative of any and all vet/kennel records.

I agree to the above terms of release.

Yes

No

Without this agreement, this information cannot be secured and the application cannot be processed. Please also call your veterinarian in advance to authorize release of your information to Carolina Basset Hound Rescue.

Agreement

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 stated above.

Yes

No