Surrender Application | All Bassets Cherished Basset Hound Rescue, Inc.

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Name of Dog*

Color

Age*

Gender

Male
Female

Please provide the following information about your veterinarian:

Name

First Last

Organization

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please explain the circumstances surrounding this relinquishment*

Is the dog neutered or spayed?*

Yes
No

Does the dog up to date on shots?*

Yes
No

Does the dog get along with other dogs?*

Yes
No

Please explain.

Does the dog get along with cats?*

Yes
No
Unknown

Does the dog get along with young children (9 and younger)?*

Yes
No

Does the dog get along with school age children (10 and over)?*

Yes
No

Please explain

Is the dog housebroken?*

Yes
No

Please Explain

Has the dog bitten a person or other animal?*

Yes
No

Please Explain

Has the dog displayed any aggressive behaviors such as food aggression or toy aggression?*

Yes
No

Please Explain

Does the dog have any behavioral problems?*

Yes
No

Please explain

Does the dog have any medical problems?*

Yes
No

Please explain.

How long have you owned the dog?*

Please attach a recent photo of the dog:*

Accepted file types: jpg, jpeg, png, Max. file size: 256 MB.

Please provide any further information that you feel is pertinent

Where did you get your basset hound from?*

All of the information that is included in this form is to the best of my knowledge, true and complete. I understand that falsifying information on this form, or at any other time during the relinquishment process may disqualify my Basset from acceptance into ABCBHR, Inc. I am aware that submitting this form does not guarantee that my Basset will be accepted into ABCBHR, Inc. I also understand that by submitting this form, I give ABCBHR, Inc permission to access my veterinary records.

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