Adoption Application

Name*

First Last

Co-applicant

Email*

Address of applicant*

U.S. address/zip codes
Canadian address/postal codes

Please select which address style you need to fill out

Address*

Street Address Address Line 2 City State ZIP Code

Address*

Street Address Address Line 2 City Province Postal Code

Phone*

How many members are in your household?

How many children are in the household? (under 18 years old)*

Ages of children living in your household?

Use commas between values. Write "N/A" if no children.

If no children in the home, would the dog be exposed to small children (grandkids for ex.) on a regular basis?

Yes
No

How many children?

What are the children's ages?

Use commas between values. Write "N/A" if no children.

How long, in hours, would a dog be left alone in your home on any given day?

Are you established with a veterinarian?*

Yes
No

Vet Name

Vet Phone

Vet Address

Have you ever owned a Basset Hound before?

Yes
No

Please tell us a little about him or her:

Have you ever owned a dog before?

Yes
No

Do you have any other pets?

Yes
No

Do you own or rent your home?*

Own
Rent

Landlord name

Landlord Phone

Is your yard fenced in?

Yes
No

If you do not have a fenced yard, how would you handle exercise, potty breaks and housebreaking?

Are you willing to have all household members present during home check?

Yes
No

Are you willing to take your new Basset Hound to the vet within 10 days of the adoption for a physical?

Yes
No

Do you have an age preference for the Basset you wish to adopt?*

Yes
No

What age range would you prefer?

Do you have a gender preference for the Basset you wish to adopt?*

Yes
No

What is the gender preference for the Basset

Please provide any further information that you feel is pertinent:

Applicant Name*

First Last

Please List Current Pet(s) and Their Ages*

Expected Date of Adoption*

Policy*

I agree to the policy stated.

All of the information that is included in 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 application process will disqualify me from adopting a Basset Hound. I am aware that submitting my application does not guarantee that I will receive approval to adopt a dog from ABCBHR, Inc. I also understand that by submitting this application, I give ABCBHR, Inc permission to access my veterinary records.

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