First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone*
Work Phone x
Cell Phone
Alt Email
Text/Pager Email
Name & Age of Each Adult in Household*
In what type of home do you live* Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing Other
Do you own or rent your home* Choose one: Rent Own Other
If you rent, have you received the approval of your landlord to have an animal* Choose one: Yes No N/A
Is there a size/weight limitation on allowable dogs?
If you rent, please enter your landlord's name and phone number*
Is your yard fenced* Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced Other
What type of fence* Choose one: Privacy Chain Link Invisible No Fence Other
What are the ages of the children in your home?*
Does anyone in the household have allergies?
Please describe the allergies
Who in the household will care for the pet*
How much time will the animal spend alone during the day*
How close is your nearest neighbor?
Will this be your first pet?*
What pets did you previously own?
What happened to them?
What pets do you currently own?
If you currently own a dog, is it neutered/spayed?*
What is the breed, age and sex of your current dog?
Please tell us the name(s) of your current dog(s)
Veterinarian's Name and Phone Number **Please notify your vet practice that someone from Tristate will be calling them, and provide your authorization for the practice to talk to the screener.*
Why do you want to adopt a basset hound?
What sex do you prefer?*
Do you agree to have your Basset Hound spayed/neutered if not already done?*
Where will your Basset Hound spend most of its time?*
Do you agree to return your Basset Hound to us if you are unable to keep it?*
How were you referred to Tri-State Basset Rescue?
When will you be ready to adopt?*
Signature: (type in signature(s)
Date
Additional Info and/or Comments: *
A FEE OF $400 FOR ONE DOG OR $600 FOR A PAIR IS REQUIRED, payable at time of adoption. Tri-State Basset Hound Rescue can not guarantee the breeds of any mixed breed dog. All dogs are spayed/neutered and inoculated prior to final adoption. Adult dogs are also heartworm tested prior to final adoption. Tri-State Basset Hound Rescue reserves the right to deny any application. If you do not hear from us, please email Dana Mania at dana@tristatebassets.org to follow up.
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