| Your Name: * |
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| Address: City, State, Zip Code: * |
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| Home Phone Number: * |
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| Cell Phone Number: * |
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| Email Address: * |
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| Occupation: * |
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| Place Of Employment: * |
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| Are You Adopting For Yourself?: * |
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| Have You Ever Had A Basset Before? If so, please tell us about them...names, ages, personalities:* |
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| List The Name(s), Age(s) and Relationship To You Of All Person(s) Living In Your Home:* |
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| Which Member Of The Family Will Be Taking the Major Responsibility of caring for this basset?: * |
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| Is anyone home during the day?: * |
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| Where do you plan on keeping your basset while you are away from home?: * |
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| Has EVERY person living in your home been around a dog before for extended times without experiencing allergy symptoms?: * |
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| What type of home do you live in - House, Apartment, Condo or Other?: * |
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| Does your association permit pets and if so what are weight restrictions, number of pets, etc?:* |
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| If you rent your home, do you have permission to have pets from your landlord?: * |
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| If you rent, may we contact your landlord to confirm permission to have pets and if so, what is the contact information?: * |
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| Please list each pet you currently have living in your home, along with their name, age, breed, sex, are they neutered/spayed, up to date on vaccinations and current on heartworm/flea and tick prevention: * |
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| Please list the name and breed of any pet you have had in the last five years? Also list why they are no longer in your care.: * |
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| Please provide the name, address and phone number of any veterinarian that has treated your pets in the last five years?: * |
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| Do you have a fenced in yard?: * |
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| Do you have a pool and if so, is it fenced?: * |
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| De you have a screened patio?: * |
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| What type of floor coverings do you have in the areas where the basset will be staying?: * |
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| If you live in an apartment or condo, what floor do you live on?: * |
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| Have you applied to adopt a dog from any rescue within the last five years and if so, please list the name of the rescue, the location of the rescue and whether you were approved to adopt from them: * |
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| Have you ever turned in an animal to an animal shelter and if yes, why?: * |
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| Have you ever put a pet to sleep for any reason and if so, why: * |
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| If you have current pets, what are your plans on how you will introduce your new basset to them?: * |
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| What steps will you take if your new basset has a hard time adjusting to your current pets?: * |
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| How will you house train your basset?: * |
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| How long do you think it will take for your new basset to adjust to their new home?: * |
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| What will you do if your new pet has a hard time adjusting to his/her new home?: * |
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| Are you planning on adding a child(ren) to your family, and if so when?: * |
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| If your family situation changes (divorce, separation, move), what are your plans for your basset?: * |
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| If you can no longer care for your basset, who will care for them?: * |
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| What about you makes you an awesome parent for one of our bassets?: * |
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| Please list two personal references (Name, Address, Relationship To You and Telephone Number): * |
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| Please use this space to tell us anything you would like us to know about you and for any questions you want us to answer for you: |
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| By typing your name in this box, you certify that all answers you have provided are true, correct and complete and you hereby authorize your veterinarian to give Basset Rescue of Florida, Inc. any and all information they request about my present and past pets. I also authorize Basset Rescue of Florida to contact any person I have listed in this application.: * |
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| Date: * |
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