Are you a previously approved foster or adopter for BROOD? *

Applicant First Name *

Applicant Last Name *

Co-Applicant First Name

Co-Applicant Last Name

Street Address *

City *

County *

State * AL AK AZ AR CA CO CT DC 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 WV WI WY -Terr.- AS FM GU MI PR VI

Zip *

Home Phone *

Work Phone

Cell Phone

E-mail Address: *

Preferred means of contact *

How many people are there in your household? *

Ages of minor children?

Are there other children who visit freuqently? (grandkids, babysitting, etc.) *

If yes, what are the visiting children’s ages and how often will they visit?

What is your household’s activity level? *

Approximately how long would the dog be left alone within a 24-hr period? *

If the dog will be left alone for longer than 5 hours, please describe in detail how your dog will be cared for (dog walker, dog door, etc.)

Do you plan to crate your dog? *

If yes, how long will the dog be crated each day?

Your home is currently *

What most closely describes your type of home? * HouseApartmentHigh RiseTownhomeCondoTrailerFarm

Do you have a dog door? *

Do you have a fenced area or yard for the dog? *

If yes, what kind of fence?

If you do not have a fence, where and how will the dog be exercised and allowed to use the bathroom?

Do you agree to keep the basset on a leash when outdoors and not in a fenced area? *

Are you established with a veterinarian? *

Name of Vet or Vet Clinic/Hospital

Vet Street Address

Vet City

Vet State AL AK AZ AR CA CO CT DC 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 WV WI WY -Terr.- AS FM GU MI PR VI

Vet Zip

Vet Phone

Vet Fax (A fax number OR email is REQUIRED to process your application.) *

Vet Email: (A fax number OR email is REQUIRED to process your application.)

Under what name is your vet account listed?

Do you currently own a dog(s)? *

If yes list names, breeds, ages of all dogs.

Have you ever owned a basset hound? *

If you have owned dogs in the past, what happened to the dog(s)? *

Describe the temperament of dogs you currently own. (Check all boxes that apply) *

Describe the adtivity level of dogs you currently own. (Check all that apply) *

Do you have any other pets (birds, rabbits, etc) in the household? (Do not include dogs and cats.) *

If yes, please list names, types and ages of other pets.

Do any of the pets have medical conditions? *

If yes, please describe the medical condition.

Do you have cats? *

If yes, have your cats ever been around a dog? *

What is your cat’s disposition towards dogs? (Check all that apply.)

What would you do if your cat did not get along with a foster dog?

Have you ever adopted a dog? *

If yes, from where? Please provide name, address, phone and contact name (if known).

If you have previously adopted from BROOD, when? (approximate date is ok)

What was the dog’s name when with BROOD?

Have you moved since you last adopted from BROOD?

If yes, explain.

Have you previously fostered for BROOD, when? (approximate date is ok)

Have you ever fostered a dog for another organization? *

If yes, for whom? (Please list name, address, phone, email, contact person)

Have you ever taken a basic dog obedience course? *

Please rate yourself on your ability/experience with training dogs, including housetraining, basic manners like sit and come when called, and on retraining for dogs with problem behaviors such as chronic barking or chewing. (Pick the choice that most closely matches your experience level) *

Please provide details of your experience with training dogs *

Are you currently fostering any dogs or cats for other groups or organizations? *

If yes, please list name, address, phone, email, contact person.

How much active exercise will your foster get every day? *

What would be your primary level of exercise with the foster? (Check all that apply.) *

Where will your foster sleep? *

Do you have neighbors who would be bothered by a barking or howling dog? *

Foster Home Responsibilities: Please review the following responsibilities of BROOD foster homes.
Sign a yearly Foster Agreement
Maintain yearly membership with BROOD
Submit regular foster reports, photos and videos of your foster
Take your foster for routine and emergency veterinary care if needed. (BROOD will reimburse any pre- approved veterinary care required for your foster.)
House train or crate train your foster dog if needed
Notify the BROOD Foster Director of any behavioral or health problems
Provide food and shelter for your foster
Meet with prospective adopters and provide input regarding the suitability of prospective adopters
Assist with adoption paperwork for the dog to a qualified adopter
Relinquish the foster dog to the approved adopter
I Agree to the above.

Please use this space to provide any additional information you feel is pertinent.

Verification Code:

Enter Verification Code: *

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