Basset and Beagle Rescue of the Heartland

Adoption Application

 
 

 

 

 

1) Your Name  
  Address  
  City  
  State  
  Zip Code  
  Home Phone Number  
  Alternate Phone Number  
  Email  
 

Occupation(s)

  

 

2) Number of Children        

Name and Ages of Children

  
 
 
 

 

3)

I would allow someone from BBRH to do a home visit?

  

 

4) Please mark which of the following best describes your current living situation:  
  Ownership  
  Type  
  Location  
     
 

If you Rent or Lease, list the name, address, phone number of your Landlord or Property owner, who holds your lease/rental agreement:
  Landlord/Property Owner  
  Address  
  City  
  State  
  Zip Code  
  Phone Number  

 

  How long have you lived at this address? YearsMonths  
     
  Besides your immediate family, are there others residing in your house?  
  If Yes, please provide Name and Relationship  
   
   
   
     
  Does your home have a yard?  
  If Yes, is it fenced?  
  What typed of fence?  
  How tall is the fence  
       
  Is someone home during the day?  
  If no, where will the dog stay while you are gone?  
  How many hours will the dog be alone during the day?  
 

Where will your dog be kept most of the time? 

  
     
  Do you have any other pets?  
  If Yes, Please provide the following information  

 

  Name Type (Dog, Cat, Etc) Age Current on Vaccinations? Neutered/Spayed?  
   
   
   
   
   
  If you checked no to either question above, please provide details:

 

  Are your animals on heartworm preventative?  
       Type?  
  Have you ever had a neighborhood complaint filed with animal control?  
       (If yes, describe)  

 

5) Your Veterinarian  
   Name
  Address
  City
  State
  Zip Code
  Phone Number
  If applicable, approximate date of your current pet's last office visit:
     
  Have you ever had to give a dog up?
  If yes, what was the circumstance:
 

If you have owned other dogs and do not now, what happened to them?

 

     
6) Your Preferences  
  Is there a dog on our web page that you are interested in?
  If yes, which one? 
  What sex do you prefer?
  Age range?
  Which breed do you prefer?
 

What kind of personality are you looking for?
  Which of the following behaviors are you willing to work with:

Not Housebroken     Chewing    

Lack of Manners  Special Needs

Needs socialization with other animals

Has not been around ChildrenHas been abused
     
7) Care of your adoptive dog:  
  How much do you estimate to spend in vet bills
for your new dog each year?
  Which brand of dog food will you be feeding your dog?
  Which kind of Heartworm Preventative do you plan to use?
     
8) Living With Your Basset Hound or Beagle:  
  Have you ever owned a Basset Hound or Beagle?
  If yes, tell us about your Basset Hound or Beagle.
  Why do you want a Basset Hound or Beagle?
  What are your favorite qualities in the breed?
  What are your least favorite qualities in the breed?
 

Check any of the following you feel are valid reasons for giving away a pet:

Fleas                     Getting married/divorced  

Having a baby      Grown and isn't cute anymore

Sheds too much   Relocating to another State/Country

Too expensive      Child(ren) will no longer take care of it             

Found a new place to live but they don't allow pets

Chews or destroys household objects
     
  What are you expecting from your rescued dog?

Previous obedience training     Good manners      Housebroken

Some behavioral problems       Wild, unruly and hard to control

Other (specify) 

  How will you socialize the Basset Hound or Beagle that you adopt?
  How did you hear about Basset and Beagle Rescue of the Heartland?
  List any Humane Societies, Organizations, Breed or Training Clubs you are associated with
     
 

We will attempt to provide you with an honest evaluation of temperament on any dog we have to place.  Do you realize that often times the complete history of a rescue dog may not be known and you may encounter some behavioral problems?
  Are you willing to work with us on correcting these problems?
     
9) References:  
 

Please include address, phone number and how long known

  

 

  Name Address Phone Number Known(yrs-mos) Relationship
 
 
 

 

10) Additional Comments:  
 
     
11) Volunteer  
  Are you interested in volunteering to help with Basset Rescue?
  If so, please check the following areas where you may be able to assist us

Fostering

     Short Tem

     Long Term

Transportation

Fund Raising

Special Projects

Veterinary Services

Other

     Please Specify:

 
  Do you want to be notified of upcoming events by joining our mailing list? We will not share of sell you e-mail address.

I certify that the information provided on this form is true and correct, to the best of my knowledge. I am also financially and physically able to care for this animal. I understand that proper food and veterinarian care can be costly and I am able and willing to meet these requirements. Home checks are made on a random basis following or prior to adoption. If upon inspection we find that the information contained in this application to be false, we retain the right to deny your application and/or remove the animal from your premises without a refund of monies paid.
BBRH  RESERVES  THE  RIGHT  TO  REFUSE  ADOPTION  FOR  ANY  REASON

 

 
 

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