How did you learn about BROOD?
Why are you interested in fostering?

A successful adoption depends on both the selection of the right basset for the "adopter's" household and the understanding of his caretaking needs that the "foster" provides us.  As the foster, your role is to assess the adoptability and behavioral characteristics of the dog while it is in a normal family environment.  

Please answer the following questions as completely as possible.

How many people are there in your household?  Ages of minor children?

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

Are you established with a vet?  Yes   No

If yes, please provide veterinarian's name, address and phone number:

Vet's Name:
Address:
City:		State:	Zip:
Phone:		Fax:

Have you ever owned a dog?   Yes  No    Have you ever owned a Basset Hound?  Yes  No

If yes, what happened to the dog, or any other dogs you have owned:

Do you have any other pets (birds, cats, etc) in the household?  Yes  No

If yes, please list:

Do you currently own  or rent your home?

IMPORTANT:  If you rent you MUST have proof of your legal ability to keep a dog (i.e., a copy of your lease, written letter from the landlord, tenants association or rental office, etc.) available for inspection when your home visit is performed.

What most closely describes your type of home?  House  Apartment  Townhome  Condo  Trailer  Farm

Do you have a fenced area or yard for the dog?  Yes  No

If yes, what type of fence:

If no, how do you plan to exercise your foster dog?

Have you ever taken a basic dog obedience course or any other type of training with a dog?  Yes  No   

Please rate yourself on your ability/experience with training dogs, including housetraining, basic manners like "sit" and "come when called" and on retraining fro dogs with problem behaviors such as chronic barking or chewing (pick one of the choices below):

(a) I do not have a lot of experience, but am willing to attend training classes to learn more. (no experience)

(b) I have experience training my own dog(s) to be housebroken and with basic commands, but have not attended obedience classes OR I have attended only a puppy socialization class. (a little experience)

(c) I have housetrained multiple dogs and attended obedience classes, and feel comfortable with housetraining and providing basic manners training to a new dog. (experienced)

(d) In addition to the statement in (c) above, I have successfully worked with a dog with a serious or chronic behavior problem such as separation anxiety, chronic barking, fearfulness, or aggression. (advanced experience)

Please provide details:
         

Have you ever had a dog with a behavior problem?   Yes  No

If yes, please provide details and what actions you took to correct it:

Have you ever had a dog with a health problem?   Yes  No

If yes, please provide details:

Have you ever "adopted" a dog?  Yes  No

If yes, from where? Check all  that apply:

City/County Shelter  SPCA  Humane Society  Rescue Group  Private Shelter  
Other

Have you ever "fostered" a dog?  Yes  No

If yes, from where? Check all  that apply:

City/County Shelter  SPCA  Humane Society  Rescue Group  Private Shelter  
Other

If necessary are you willing to:
	House train your foster dog?	Yes  No
	Work with a behavior problem (e.g., fear, dominance, aggression, barking, separation anxiety)?	Yes  No
	Work with a health problem (e.g., blindness, heartworm positive, Addison's disease, etc.)?	Yes  No
	Crate train your foster?	Yes  No
Do you understand that may be required to:
	Take your foster for routine and emergency veterinary care, including dental work?	Yes  No
	Take your foster to training?	Yes  No
	Meet with prospective adopters?	Yes  No
	Transport foster dog to adoptathons?	Yes  No
	Attend foster training?	Yes  No
Do you understand that:
	You will have to sign a Foster Agreement?	Yes  No
	You will be responsible for providing food and shelter for your foster?	Yes  No
	BROOD will reimburse any veterinary care required for your foster?	Yes  No
	BROOD requires routine Foster Reports (a questionnaire designed to tell us about how the dog is doing, and provide prospective adopters with relevant info)	Yes  No
	The foster dog is not YOUR dog, but a BROOD dog and that any decisions pertaining to his health and well-being must be made with BROOD's concurrence and approval?	Yes  No
	As a foster parent, you will be expected to relinquish the dog to a qualified adopter?	Yes  No

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

All the information I have provided on this application is, to the best of my knowledge, true and complete.  I understand that falsifying information on this application, or at any other time during the process, disqualifies me from fostering.

By submitting this application, I hereby authorize my veterinarian to disclose my vaccination records to BROOD Inc.

                          

AS REQUIRED BY THE CODE OF VIRGINIA, CHAPTER 787 3.1-796.96.C.3, 
I/WE ALSO CERTIFY THAT I/WE HAVE NEVER BEEN CONVICTED 
OF ANIMAL CRUELTY, NEGLECT OR ABANDONMENT.