BHRG * P.O. Box 680322 * Marietta, GA * 30068-0006 * 770.499.1164

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All fields with a * are required.

*Name
	(please include the name of your partner or spouse, if applicable)
Name of Parent or Guardian
	(if under age 18)
*Address
*City
*State	Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam 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
*Zip
*Home Phone
Work Phone
Work Hours	From    To
Cell/Pager
*E-mail

*Please tell us how you heard about BHRG?	Select One Web Search Engine Link from Another Website Friend or Family Veterinarian Animal Shelter PETsMART Newspaper or Magazine Other
So we can determine which advertising works best, please give more specific information about how you heard of BHRG.

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We work hard to find good matches between foster families and homeless bassets. So that we may understand your lifestyle, please answer the following questions as completely as possible. Thank You.

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*Do you own or rent your home?	OwnRent
*Type of dwelling	House
	Condo
	Apartment
	Mobile
*How long have you lived at your current address?	Select One Less than 1 year 1 to 5 years 6 to 10 years More than 10 years
Leasing Manager Approved?	YesNo
Leasing Manager's Name
Leasing Manager's Phone Number
Parent(s)/Roommate(s) Approved?	YesNo
Parent(s)/Roommate(s) Name
Parent(s)/Roommates(s) Phone Number

*Do you have a fenced-in yard for the dog?	YesNo
What type of fence is it? Check all that apply.	Chain Link
	Privacy
	Picket
	Invisible
	Attached
	Not Attached
	Dog Pen
	Dog Run

Fence Dimensions
Length	Width	Height

*Do you have a pool, pond or hot tub in your yard?	YesNo
If yes, is there a fence around it?	YesNo
Are you willing to reinforce or repair your fence if needed?	YesNo
If no fence, what arrangements will you have for the dog's exercise and toilet duties?

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*Have you ever owned a pet before?

YesNo

What happened to your previous pets?

*Have you ever owned a basset hound before?

YesNo

*Do you presently have other animals?

YesNo

	Please complete the following for each of your current pets.

Pet's Name	Type (dog, cat...)	Breed	Gender	Spayed/ Neutered	Age	Years Owned	Next Shots Due (MM/DD/YY)	Type of Heart- worm Prevention

Please tell us why any of your pets are not spayed or neutered (if applicable).

*Are you established with a vet? YesNo Vet Clinic Name? Vet Clinic Phone Number?

What is your occupation?

*Number of Adults in Household? Select One 1 2 3 4 More Than 4   *Number of Children in Household? Select One None 1 2 3 4 More Than 4

Ages and genders of children?

How do other family members feel about fostering a basset?

*Is anyone home during the day? YesNo *At night? YesNo

*Where will the dog be kept during the day? *At night? *When you're away?

*Is anyone allergic to dogs? YesNo

*Tell us your preferences for your foster basset (for example, you have a female basset who only likes males)...

*Are you willing to foster a bonded pair of bassets? YesNo

Please understand that we know very little about bassets coming to us from shelters. Some have problems, but many do not. We really won't know much about the dog until the he is placed in your foster home and you have a chance to evaulate the dog.

*Are you prepared to take resposibility for a basset until it is adopted. YesNo

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Would you also like to volunteer in any of these other ways?

Help with Transportation Help with Home Visits Help with Special Events

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By submitting this form, you agree to the following statement: 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 foster process disqualifies me from becoming a foster home.

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Please click this button only once.

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[ Home |

BHRG & Basset Info |

Adoption |

The Dogs |

Success Stories ]

[ Volunteer |

Help Us |

BHRG Gear |

Links |

Thank Yous |

Contact Us ]