First Name*

Last Name*

Email*

What is the name of the dog you are applying for?*

What is your birthdate?*

Your Spouse's Name

Your Spouse's Last Name

Is your spouse or domestic partner on board with this adoption?*

Street Address*

Apt. # or Suite

City*

State*

Zip Code*

Phone Number

Why do you want to adopt this pet?*

Do you have experience with basset hounds?*

Do you have children? If yes please list their names and ages:*

Have your children had pets before?

Who will be responsible for pet's daily care? *

Have you ever owned a pet?*

If yes, for how long?

Have you ever given up a pet?*

If yes, why?

Please list the name, breed/type, sex, age and whether altered or not of any pets living in your household:

Please inform your veterinarian that we may be contacting them and give them permission to speak with us.

Veterinarian Name/Business and phone number:*

Please inform your references that we may be contacting them and give them permission to speak with us.

Please provide two personal references with contact info (phone # & email): (PLEASE DO NOT LIST FAMILY MEMBERS OR OTHER RELATION AS A REFERENCE.)*

What type of area do you live in?*
Choose one: Rural Suburb Urban

Do you rent or own your home?

If renting, are pets allowed?

If renting & pets are allowed, what is your landlord's name & number? (This may act as one personal reference):

How long have you lived at this residence?*

Do you have a yard?*

Does your yard have an above ground fence with a latching gate?*

Do you have an in-ground pool or pond?*

If yes, is the pool/pond fenced separately?

Will your pet live inside the home or outside? Why? *

How many hours will the dog be left alone on a typical weekday?*

Please describe the location where the pet will be kept when no one is home.*

On a typical day, how much exercise will your pet get & how? *

If your pet is a puppy, how do you plan to housetrain him/her?

Have you considered the damage that a puppy/dog can do? (e.g. soiling, biting/scratching, chewing, etc.) *

Have you ever taken a pet through formal obedience classes or consulted a pet behaviorist?*

Would you consider this for your new pet? *

Are you aware that, assuming your pet does not have any unusual medical conditions, yearly costs can be over $600 for the annual check-up, vaccinations, heartworm control, flea control and proper feedings?*

Are you aware that you are making up to a 15+ year commitment?*

What would happen if a family member or friend were to develop pet allergies?*

Are you willing to let us visit you at home during or after the adoption takes place? *

Do you agree to seek approval from Buckeye Basset Hound Rescue before any transfer of the pet ownership for whatever reason? *

Do you agree that ownership of the pet must be transferred back to Buckeye Basset Hound Rescue in the event you cannot keep the dog, for whatever reason?*

By clicking the Submit button below, I certify that:

- The information I have given is accurate

- I understand that Buckeye Basset Hound Rescue has the right to deny any application for whatever reason

- I give permission for Buckeye Basset Hound Rescue to call the references and veterinary practices I have listed

SUBMIT*
Choose one: SUBMIT

Please type your initials and date as a digital signature.*