Adults in household

1.

2.

Children in home

Address

Please select state AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA DC WV WI WY

Telephone

Email

Employment

What type of housing do you have? House Townhouse Duplex Condo Apartment Modular Home Farm

Do you rent or own?
Rent
Own

If you rent or lease, do you have permission from your landlord to keep a basset indoors?
Yes
No

Landlord's Name

Contact Number

Do you have a yard?
Yes
No

Is it fenced?
Yes
No

Type of fencing

Fence Height

If you don't have a fence, where and how will the dog be exercised and allowed to use the bathroom?

Are you a previous dog owner?
Yes
No

Which breeds have you owned in the PAST?

What types of animal(s) CURRENTLY live in your home? Please list name, breed, age, and how long you've owned each animal. Include dogs, cats, ferrets, rabbits, etc.

Do you currently own animals that live outside, such as other dogs, chickens, feral cats, etc? Please list.

What do you know about basset hounds as a breed?

How do your family members feel about adopting a dog? And why has your family chosen a basset hound?

Is anyone home during the day?
Yes
No

Is anyone home at night?
Yes
No

Are you willing to crate train if needed?
Yes
No

If no, please explain.

Is anyone in the house allergic to pet dander?
Yes
No

If yes, who?

Where will the basset be kept while you are away from home or working?

Where will the basset sleep or be kept at night?

Where will the basset be kept when you're away from home on vacation or trips?

Would you consider a "Special Needs" basset such as one that requires daily medication, one who needs obedience training, one who is deaf, etc?
Yes
No

What age basset are you looking for? 10 years and up 7-10 years 4-6 years 1-3 years Puppy

Are you familiar with vet costs such as annual shots, routine care and/or unexpected expenditures?
Yes
No

Are you aware of the importance of YEAR ROUND Heartworm preventive and Flea Treatments?
Yes
No

If no, please ask your vet or a CBHR volunteer for more information. Negating these treatments and preventives from your dog's routine can lead to sickness and the possible death of your pet.

Are you willing to have a Home Visit prior to adoption? Visits will be conducted virtually or in person with COVID protocols including masks and social distancing when feasable.
Yes
No

If no, please explain.

Are you willing to allow a CBHR volunteer to conduct a follow up contact after the adoption?
Yes
No

If no, please explain.

Reference Information

If you have owned a pet in the past two years, please provide veterinary name and contact information below.

If you have NOT owned a pet in the past two years, please provide the following reference information: A personal reference, not related to you and not living at the same address. (Provide personal reference ONLY if you have not owned a pet in the last two years.)

Release of Veterinary Information

I authorize any veterinarian or veterinarian hospital/professional/kennel to furnish or discuss with any representative of CBHR all records in their possession regarding the care of their animals past or present. This information will be used in the adoption process of one or more dogs in the care of CBHR. I understand this authorization shall remain valid for one year after the date it is submitted. Upon presentation of this document, a photocopy or facsimile of same, you are directed to permit the personal review with a CBHR representative of any and all vet/kennel records.

I agree to the above terms of release.

Yes

No

Without this agreement, this information cannot be secured and the application cannot be processed. Please also call your veterinarian in advance to authorize release of your information to Carolina Basset Hound Rescue.

Agreement

All of the information I have provided on this application is, to the best of my knowledge, true and complete. I understand falsifying answers on this application, or at any other time during the adoption process, will disqualify the household I represent from adopting a basset from Carolina Basset Hound Rescue (CBHR).

I understand that the processing of this application is contingent upon CBHR being able to find a volunteer who is willing to conduct the in-person home visit. If CBHR is not able to provide a volunteer for the home visit, the application fee will be refunded.

I understand that submitting an application is no guarantee that I will receive a CBHR basset. I further understand that placement of these bassets is at the sole discretion of CBHR and a reason for rejection of an application need not be given. Upon completion and signing of this application and release of any veterinary information, I wish to be considered for ownership of a CBHR basset.

I understand that if I do adopt a basset from CBHR, that should I choose not to keep the basset for any reason that it MUST be returned to CBHR. I also understand that if I do adopt a basset from CBHR, CBHR reserves the right to remove the basset from my home if it is believed that the basset is not being taken care of according to CBHR policies put forth.

I agree to the terms stated above.

Yes

No

Comments

As a final question, we would like to know how you heard about Carolina Basset Hound Rescue.

The $15 adoption application fee can be paid by PayPal or by check or money order. Please indicate your payment method below:

PayPal

Check or money order

Payment information will appear on the next page, after you click the Submit Application button below.