Adoption Application Name* First Last Co-applicantEmail* Address of applicant* U.S. address/zip codes Canadian address/postal codes Please select which address style you need to fill outAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon 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 NameVet PhoneVet AddressHave 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 nameLandlord PhoneIs 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 BassetPlease 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* MM slash DD slash YYYY 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.CAPTCHA
