BellyRubs Basset Rescue
Adoption Application Form

A successful adoption depends on both the selection of the right basset hound for your household and the understanding of his/her care taking needs.  So that we may assist you with this selection, please answer the following questions as completely as possible.  Your confirmation and answers to these questions help us to know that you completely understand the responsibility you take on when you adopt a rescue basset hound.

Please answer the following questions as completely as possible.

Thank you.

Enter Your Name: (Husband & Wife, if married)
Your Street Address:
City: State: Zip:
Home Phone: Work Phone:
E-mail:
Work hours:
Referred by:
What is your preference for sex of the dog? No Preference Male Female
What is your preference for age of the dog? 8+ years old 2-7 years old Under 2 years
Would you be interested in: Basset Mix Special Medical Needs Senior Dog
Basset Hound you wish to adopt. Please note BRBR cannot guarantee a particular dog will be available when you are ready to adopt.

Requirements to adopt a basset from BellyRubs Basset Rescue:

1. Willing to allow the basset to live in the house and be a part of the family.
2. Securely fenced back yard if the basset is to be outdoors unattended.
3. No dogs can be staked, chained, or tied in any way!

BellyRubs Basset Rescue's adoption fees are -

For a young (under 8 yr.) full blooded basset hound - $150.00.
For a senior (8 years or older) full blooded basset hound - $75.00.
BRBR's adoption fee for a basset hound mix - $75.00.

Do you own or rent your home?  Own  Rent

What type of dwelling is it?  House  Condo  Apartment  Mobile home

Do you have a fenced area for the dog?  Yes  No

If yes, type of area:  Kennel  Yard

Type of fencing and approximate dimensions:

If not, what arrangements will you have for the basset's exercise and toilet duties?

Have you ever owned a dog before? Yes  No

If yes, what breed(s) have you owned?

Have you ever owned a basset hound before?  Yes  No

Why do you want to own a basset hound?

Do you presently own any other animals?  Yes  No
If so, please list all animals in the home, including the sex, breed, and is spayed or neutered.

Are any of your animals altered? Yes  No
How long you have you owned your other animals?

How many adults are in your household? 

How many children are in your household? 

What are the ages of your children? (enter n/a if none) 

How do other family members feel about adopting a basset?

Is anyone home during the day?  Yes  No

Is anyone home at night?  Yes  No

Is anyone in the home allergic to dogs?  Yes  No

Are you willing to house train a basset hound, if necessary?  Yes  No

Where will the basset hound be kept during the day 

Where will the basset hound be kept at night? 

When you are away from home? 

Are you established with a vet (as a reference)?  Yes  No
If yes, please provide your vet's:
Name: 
Address: 
City:     State:     Zip Code: 
Your vet's and phone number:

Personal references: Name, addresse, city, state, and phone #': 

Do you agree to provide medical care (yearly shots, worming, heart wormer) for the basset that you adopt? Yes  No

Do you agree to provide fresh food and water daily for the basset hound you adopt? Yes  No

Are you willing to allow this basset to be a part of your family? Yes  No

Do you understand that basset hounds are not small dogs? Yes  No

Basset hounds can be messy at times by dragging their ears through their food and water.
Does this bother you? Yes  No

Basset hounds can be very loud with their barks or howls. Would this be a problem with anyone in your household or neighborhood? Yes  No

Basset hounds have a hound odor, some more so than others. Would the hound odor be a problem for you? Yes  No

A Basset hound's ears must be cleaned periodically to reduce odor and prevent infections. Would ear cleaning be a problem for you? Yes  No

Basset hounds shed quite frequently. Does dog hair and shedding present a problem in your household? Yes  No

Are you willing to allow the basset in your home, especially in cold or inclement weather (storms, etc.)? Yes  No

Basset hounds are scent hounds and cannot be turned loose without a lead. Do you agree that if you adopt a basset hound that you would be willing to keep the dog in a securely fenced area of your yard, or take the dog for walks on a leash if you don't have a fenced yard? Yes  No

We do not allow any of our rescue dogs to be staked, tied, or chained in any manner. Do you agree not to stake, tie or chain your basset? Yes  No

If you adopt a basset, do you understand that the basset must wear a collar with current rabies tag and BRBR tag at all times? Yes  No

If you adopt a basset, do you agree to telephone BRBR immediately if the basset should become lost or stolen? Yes  No

If you adopt a basset, do you agree to notify BRBR at least one week prior to any change of address? Yes  No

If you adopt a basset, do you agree not to transfer your basset to anyone else without prior permission from BRBR? Yes  No

If for any reason that you decide you cannot keep the basset hound, do you agree that the basset hound comes back to BRBR? Yes  No

If you decide to adopt a basset, do you agree to a 14-day trial period with that particular basset hound? Yes  No

If for any reason you do not want to keep the basset at the end of the 14-day trial period, do you understand that the basset comes back to BRBR and your money returned? Yes  No

Do you agree to home visits from the BellyRubs Basset Rescue personnel, and phone calls to check on the welfare of the basset hound?  Yes  No

Sometimes we have Special Needs basset hounds that may be harder to place.
Are you willing to adopt a dog with any of the following traits? [check all that apply]
older dog [6+ years]  basset mix  basset with special medical needs

Please let us know about any special needs or questions you may have.

Are you over 21 years of age, able to engage in a binding legal agreement, and financially capable of providing necessary veterinary care for the basset you adopt? (please type Yes or No)

By clicking on the submit button, you stipulate all of the information you have provided on this application is, to the best of your knowledge, true and complete. You understand that falsifying answers on this application, or at any other time during the adoption process, disqualifies you from adoption.

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