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 AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe 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?YesNoDo you own or rent your home?OwnRentIf Rent, please provide landlord contact infoAre you established with a veterinarian?*YesNoVet 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?*YesNoIf kids exposure is possible, what age range? 0-3 4-7 8-17Do you have a fenced yard?*YesNoPlease 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)YesNoAre you willing to take your Foster Basset outside multiple times a day to relieve him/herself, and for exercise?YesNoDo you agree to housebreak your foster dog if necessary?YesNoDo you promise to keep identification on the foster dog at all times?YesNoDo you agree to notify ABC Basset Rescue if your Foster dog is ever lost, seriously injured, or stolen?YesNoDo 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?YesNoWould you like to sign up for our newsletter?YesNoPlease 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. This iframe contains the logic required to handle Ajax powered Gravity Forms.