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All fields are required:
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Contact Information:
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1. Please provide the following contact information:
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First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Phone
Cell Phone
E-mail
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2. Best time to reach you:
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3. Are you a Member?
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Living Conditions
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4. What type of housing do you live in?
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5. Do you own or rent?
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5a. If you rent, does your landlord permit dogs?
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5b. If you rent, is there a weight/size limit on allowable dogs?
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5c. If yes, what is the weight/size limit?
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5d. If you rent, please provide your landlord's name and contact information for verification of requirements:
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Name
Work Phone
Home Phone
E-mail
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6. Do you have stairs in your home?
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6a. If yes, how many stairs?
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7. Do you have a fenced in yard?
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7a. If yes, please describe your fence (height, type etc):
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7b. If no, do you agree to keep the basset on a leash when outdoors?
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8. Are you willing to have a volunteer from BassetCARE visit your home prior to adoption?
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Dynamics of Household
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9. What is the make-up of your household?
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Number of adults
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Number of children:
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9a. If there are children in the household, what are their ages?
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10. Are there other children who visit frequently (i.e. grandkids, babysitting)?
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10a. If yes, what are the visiting children's ages?
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11. Please list the pets you currently own and provide the information requested on each one.
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Dog (Breed),
cat, bird, other
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AGE
(yr/Mos)
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Spay/
Neuter
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Date of last
heart worm test
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Date of last inoculations for:
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Time
owned
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Pet's Name
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Sex
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Rabies
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DHLPP
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Bordatella
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12. Describe the temperament of the dog(s) you currently own.
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13. Describe the activity level of the dog(s) you currently own.
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14. Do you give Heartworm preventative to your dog(s) on a monthly basis?
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15. Does anyone in the household have dog allergies?
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16. How close is your nearest neighbor?
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Veterinarian Information
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17. Do you have a veterinarian?
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17a. If yes, please provide your veterinarian's name and phone number.
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Name
Organization
Work Phone
FAX
URL
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18. What pet name and last name are your current vet records under?
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Adoption Questions
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19. Why do you want to adopt a Basset?
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20. Will this be your first dog/basset as an adult?
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21. Have you ever adopted a dog from a rescue organization or shelter?
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22. Have you ever had to give up a dog?
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22a. If yes, please explain:
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23. How do other family members feel about adopting a Basset?
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24. Which family member will be the basset's primary caregiver?
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25. How many hours per day will the basset be left alone?
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26. Where will the basset be kept during the day?
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27. Where will the basset be kept during the night?
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28. Are you willing to provide the required heartworm preventative on a monthly basis?
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29. Are you willing to provide us with follow up reports?
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30. Do you agree to return your basset to us if you are unable to keep it?
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Basset Preferences and Training
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31. Would you prefer a male or female basset?
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32. What age Basset do you prefer? (Select all the age(s) that apply.)
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33. What specific traits are you looking for in a basset that would
make him/her the right match for your family?
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34. Have you ever taken a dog to obedience training?
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35. Are you willing to take your basset to obedience training if necessary?
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36. Are you willing to house train your basset, if necessary?
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37. Are you willing to crate train your basset?
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Referral and Other Comments
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38. How were you referred to BassetCARE?
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39. If you have other comments or have a specific Basset on our website you are interested in, please indicate below.
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Thank you for your interest in adopting a Basset Hound from BassetCARE!
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