Copyright © 2011 BassetCARE, Inc.
BassetCARE Adoption Application
Please answer the following questions as completely as possible.
All fields are required:
Contact Information:
1.  Please provide the following contact information:
First Name  

Last Name   

Street Address  

Address (cont.)  



Zip/Postal Code  


Cell Phone  

2.  Best time to reach you:
3.  Are you a  Member?
Living Conditions
4.  What type of housing do you live in?
5.  Do you own or rent?
5a.  If you rent, does your landlord permit dogs?
5b.  If you rent, is there a weight/size limit on allowable dogs?
5c.  If yes, what is the weight/size limit?
5d.  If you rent, please provide your landlord's name and contact information for verification of requirements:

Work Phone  

Home Phone  

6.  Do you have stairs in your home?
6a.  If yes, how many stairs?
7.  Do you have a fenced in yard?
7a.  If yes, please describe your fence (height, type etc):
7b.  If no, do you agree to keep the basset on a leash when outdoors?
8.  Are you willing to have a volunteer from BassetCARE visit your home prior to adoption?
Dynamics of Household
9.  What is the make-up of your household?
Number of adults
Number of children:
9a.  If there are children in the household, what are their ages?
10.  Are there other children who visit frequently (i.e. grandkids, babysitting)?
10a.  If yes, what are the visiting children's ages?
11.  Please list the pets you currently own and provide the information requested on each one.
Dog (Breed),
cat, bird, other
Date of last
heart worm test
Date of last inoculations for:
Pet's Name
12.  Describe the temperament of the dog(s) you currently own.
13.  Describe the activity level of the dog(s) you currently own.
14.  Do you give Heartworm preventative to your dog(s) on a monthly basis?
15.  Does anyone in the household have dog allergies?
16.  How close is your nearest neighbor?
Veterinarian Information
17.  Do you have a veterinarian?
17a.  If yes, please provide your veterinarian's name and phone number.


Work Phone  


18.  What pet name and last name are your current vet records under?
Adoption Questions
19.  Why do you want to adopt a Basset?
20.  Will this be your first dog/basset as an adult?  
21.  Have you ever adopted a dog from a rescue organization or shelter?
22.  Have you ever had to give up a dog?
22a.  If yes, please explain:
23.  How do other family members feel about adopting a Basset?
24.  Which family member will be the basset's primary caregiver?
25.  How many hours per day will the basset be left alone?
26.  Where will the basset be kept during the day?
27.  Where will the basset be kept during the night?
28.  Are you willing to provide the required heartworm preventative on a monthly basis?
29.  Are you willing to provide us with follow up reports?
30.  Do you agree to return your basset to us if you are unable to keep it?
Basset Preferences and Training
31.  Would you prefer a male or female basset?
32.  What age Basset do you prefer? (Select all the age(s) that apply.)
33.  What specific traits are you looking for in a basset that would
make him/her the right match for your family?
34.  Have you ever taken a dog to obedience training?
35.  Are you willing to take your basset to obedience training if necessary?
36.  Are you willing to house train your basset, if necessary?
37.  Are you willing to crate train your basset?
Referral and Other Comments
38.  How were you referred to BassetCARE?
39.  If you have other comments or have a specific Basset on our website you are interested in, please indicate below.
Thank you for your interest in adopting a Basset Hound from BassetCARE!