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Basset and Beagle Rescue of the Heartland Adoption Application

Who are you Name:
Address: City: State: Zipcode:
Phone (preferred): Type:
Employer Name:
Number of Children:   If you have children please type their name(s) and age(s) below

What's your place like I would allow someone from BBRH to do a home visit?   YesNo

Please mark which of the following best describes your current living situation
Ownership Lease
Live with Friend(s)
Live with Parent(s)
Type House
Military Housing
Location City

If you Rent/Lease, please provide the following information for your landlord or property owner, who holds your rental/lease agreement.

Landlord/Property Owner Name:
Address: City: State: Zipcode:
How long have you lived at this address? (years) (months)
Besides your immediate family, are there others residing in your hosue?   YesNo
  If yes, relationship and name

What will life be like for your new furry family member Does your home have a yard?   YesNo
If yes, is it fenced?   YesNo
  Fence Type: Fence Height:

Is someone home during the day?   YesNo
  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?   Inside Outside Basement Other
Do you have any other pets?   YesNo   If Yes...

Name Type (dog, cat, etc.) Age Current on Vaccinations Neutered/Spayed

YesNo YesNo

YesNo YesNo

YesNo YesNo

YesNo YesNo

  If you checked no to either question above, please provide details here
Are your animals on heartworm preventative?   Yes No   Type:

Have you ever had a neighborhood complaint filed with animal control? Yes No
  If yes, please explain

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

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

Pick Your Pup Is there a dog on our web page that you are interested in?   YesNo
  If yes, which one?
What sex do you prefer?   Male Female No Preference
Preferred Age range?
Which breed do you prefer?   Basset Hound Beagle

What kind of personality are you looking for?   Energetic Relaxed, yet playful Calm and laid back

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 Children Has been abused

Expectations 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?
Have you ever owned a Basset Hound or Beagle?   YesNo
  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 Grown and isn't cute anymore Having a baby Sheds too much Too Expensive Child(ren) will no longer take care of it Relocating to another State/Country Chews or distroys household objects Found a new place to live but they don't allow pets

What are you expecting from your rescued dog? Previous obedience training Good manners Housebroken Some behavioral problems Wild, unruly, and hard to control

Other Expectations

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?

References Please include address, phone number and how long known

Name Address Phone Known for (years/months)

Additional Comments

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.

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