Foster Application Please complete all information before submitting:Name* First Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Work PhoneHome PhoneMobile PhoneFaxHow did you hear about us?How many members are in your household?Are all members of household in favor of becoming a foster family? Yes No Do you own or rent your home? Own Rent If Rent, please provide landlord contact infoAre you established with a veterinarian?* Yes No Vet NameVet PhoneVet AddressHow often will the basset be left alone during the day?How often will the basset be left alone during the night?While you are away, where will the basset hound be?Briefly explain your interest in fostering a basset:Do you have exposure to kids?* Yes No If kids exposure is possible, what age range? 0-3 4-7 8-17 Do you have a fenced yard?* Yes No Please list current pets (including non-cat/dog) in the house and sex/ages:Do you agree to assume the responsibility of veterinary care for your foster basset? (Approved veterinary costs will be paid by ABC Basset Rescue, Inc) Yes No Are you willing to take your Foster Basset outside multiple times a day to relieve him/herself, and for exercise? Yes No Do you agree to housebreak your foster dog if necessary? Yes No Do you promise to keep identification on the foster dog at all times? Yes No Do you agree to notify ABC Basset Rescue if your Foster dog is ever lost, seriously injured, or stolen? Yes No Do you understand that while the basset is in foster care He/she remains the property of ABC Basset Rescue, and Can not be placed without the consent of an ABC representative? Yes No HiddenWould you like to sign up for our newsletter? Yes No Please agree to the following:* I agree as stated below.In submitting this document, I acknowledge that I have fully answered the above listed questions honestly, and to the best of our ability. I understand that when we foster a dog, we are accepting the dog as is, and full responsibility for its actions while in our care. No warranty or guarantee is either intended or given as to the physical condition or temperament of these foster dogs, as many times, their background is unknown. ABC Basset Rescue will make every effort to place the dog in a timely manner. ABC Basset Hound rescue will not be responsible for any misrepresentation of the dog being placed in your home for temporary foster care. I have read and understand this statement.