ALL BASSETS CHERISHED BASSET HOUND RESCUE, INC.

P.O. BOX 54

LEROY, NEW YORK 14482

 

 

 

ADOPTION APPLICATION

 

(Please Print)

 

Name: _______________________________________________________________________

 

Address: ____________________________________________________________________

 

City: _______________________ State:__________________ Zip: __________________

 

Home Phone: _________________________   Work Phone: _________________________

 

Email Address: ______________________________________________________________

 

How did you hear about ABC Basset Hound Rescue, Inc.? _______________________

 

_____________________________________________________________________________

 

So that we may assist you in selecting the right Basset Hound for your home,

please answer the following questions as completely as possible.  Thank you.

 

How many members are in your household: ___________ Ages of children_________

 

How long would the dog be left alone within a 24 hr. period?_________________

 

Are you established with a veterinarian? _____YES  _____NO

 

Please provide the name, address and phone number of your vet:

_____________________________________________________________________________

 

_____________________________________________________________________________

 

_____________________________________________________________________________

 

Have you ever owned a dog? ____YES  ____NO if so, what kind: ________________

 

If yes, what happened to the dog: ___________________________________________

 

_____________________________________________________________________________

 

Are there pets in the household? ___YES  _____NO

 

If yes, what kind: __________________________________________________________

 

Would this dog primarily be an inside dog? _____YES  _____NO

 

Do you own your home or rent? _______________________________________________

 

If you rent, please provide name, address and phone number of landlord:

 

______________________________________________________________________________

______________________________________________________________________________

 

____________________________________________ Phone: __________________________

 

Do you have a fenced yard? ____YES _____NO

 

Are you willing to have a home visit prior to the adoption?  ____YES  ____NO

 

Are you willing to take your new basset hound to the vet within 10 days of the

 

adoption for a physical?  ____YES   ____NO

 

Do you have a preference in the Basset you wish to adopt?

 

Age: _______ Sex: _______

 

Please provide any further information that you may feel is pertinent: ______

 

_____________________________________________________________________________

 

_____________________________________________________________________________

 

 

All the information that is included in this application is to the best of my knowledge, true and complete.  I understand that falsifying information on this application, or at any other time during the application process, disqualifies me from adoption.

 

I am aware that submitting my application does not guarantee that I will receive approval to adopt a dog from ABC Basset Hound Rescue, Inc.

 

By signing this application, I authorize ABC Basset Hound Rescue, Inc. access to my veterinary records.

 

 

________________________________________________             _________________

Signature                                                    Date