Foster Application A foster carer must be 18 years and over Subject: Personal Details: Title (required) MrMrsMsMissOther First Name (required) Last Name (required) Address line (required) Suburb-city (required) Post Code (required) State (required) Phone or Mobile (required) Your Email (required) Best time to call: About You and Your Family Age: ---18-2526-3637-4647-5657-6667-76Over 76 Your Occupation: How many other adults are living in the household: How many children are living in the household: Ages(s): Are you expecting a child or planning a family: YesNo Do children regularly visit your home YesNo Is your home: ---House YardApartment/UnitTown HouseCaravanHouse AcreageOther If renting does your landlord allow dogs: YesNoNot Sure Your Neighborhood is:Inner CitySuburbanRuralRemote Describe your yard and fence: Do you currently own dogs YesNo Please list all other dogs in your household, names, age, sex, breed and how long you have owned them: Do you have other animals?: YesNo Please list details on other animals: Do you use crating for sleeping or containing your dogs:YesNo Your Veterinarian Contact Details Name of veterinary practice or hospital: Name of your regular Veterinarian: City/State/Postcode: Phone: Your Basenji Knowledge Have you owned a Basenji:YesNo If yes, please provide some information on your past Basenjis: Have you foster Basenjis before:YesNo If yes, please give details: About the Basenji You Will Foster Gender: MaleFemaleEither Age: ---Puppy1 to 4 yrs5 to 8 yrsOlder than 8 yrsAny age Where will the Basenji sleep: Who will be the primary care giver: How long will the Basenji be alone during the day: Is there anything else to say: