BellyRubs Basset Rescue Adoption Application

Name: ________________________________________________________________
           (Husband & Wife, if married)
Address: _______________________________________________________________

City, St., 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 ___Dog with Special Medical Needs ___ Senior Dog

If you are interested in one of the dogs currently available please specify his/her name. _____________________________
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:

BellyRubs Basset Rescue's adoption fees are -

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

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.

Thank you.

Please answer the following questions as completely as possible.

Do you own or rent your home? Rent ____ Own _____

Type of dwelling:
House _____ Condo _______ Apt ______ Mobile home _______

Do you have a fenced area for the dog? ________
If yes, type of area: Kennel? _______ Yard? ________
Type of Fencing? _______________

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

Have you ever owned a dog before? __________
Breed/s owned? ___________________________________________________

Have you ever owned a basset hound before? ______

Why do you want to own a basset hound? _____________________________
________________________________________________________________

Do you presently have other animals? ___________
What type? ________________________________________________
What breed? _______________________________________________
Male or female? ________ spay/neutered? ________
How long have you owned your animals? __________

How many adults are in your household? __________
How many children are in your household? ________
What are the ages of your children? _________

How do other family members feel about getting a basset? ________________________________________________________________
________________________________________________________________

Is anyone home during the day? ___ At night? ____

Is anyone in the home allergic to dogs? ___________

Are you willing to house train the dog if necessary? _________

Where will the dog be kept during the day? ____________________
At night? _______________________________________________
When you are away from home? _____________________________

Are you established with a vet? _______
Vet's Name: ________________________________________________
Address: ___________________________________________________
___________________________________________________________
Phone number: ______________________________________________

Personal references:
Names, addresses, phone #'s:
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________

Do you agree to provide medical care (yearly shots, worming, heartwormer) for the basset that you adopt? _____

Do you agree to provide fresh food and water daily for the basset hound you adopt? _______

Are you willing to allow this basset to be a part of your family? _____

Do you understand that basset hounds are not small dogs? _________

Do you understand that basset hounds can be messy at times by dragging their ears through their food and water? ____ Does this bother you? _____

Basset hounds can be very loud with their barks or howls. Would this be a problem with anyone in your household or neighborhood? _________

Basset hounds have a hound odor, some more so than others. Would the hound odor be a problem for you? _____

A Basset hound's ears must be cleaned periodically to reduce odor and prevent infections. Would ear cleaning be a problem for you? _____

Basset hounds shed quite frequently. Does dog hair and shedding present a problem in your household? __________

Are you willing to allow the basset in your home, especially in cold or inclement weather (storms, etc.)? ______

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? _____

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? _____

If you adopt a basset, do you understand that the basset must wear a buckle collar with current rabies tag and BellyRubs Basset Rescue tag at all times? ______

If you adopt a basset, do you agree to telephone BellyRubs Basset Rescue immediately if the basset should become lost or stolen? _____

If you adopt a basset, do you agree to notify the BellyRubs Basset Rescue at least one week prior to any change of address? _____

If you adopt a basset, do you agree not to transfer your basset to anyone else without prior permission from the BellyRubs Basset Rescue? ____

If for any reason that you decide you cannot keep the basset hound, do you agree that the basset hound comes back to the BellyRubs Basset Rescue? ____

Do you agree to home visits from the BellyRubs Basset Rescue personnel, and phone calls to check on the welfare of the basset hound? ___

If you decide to adopt a basset, do you agree to a 14 day trial period with that particular basset hound? _____

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 the rescue and your money returned? _____
 

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

____________________________________    ________________

Signature                                                                 date
 
 

application.htm - rev. 4/26/2007

Please mail or e-mail this application to the nearest BellyRubs Coordinator:

BellyRubs Basset Rescue	BellyRubs Basset Rescue
c/o Leanne Potts	c/o Clara Jackson
PO Box 23332	PO Box 335
Knoxville, TN 37933	Victoria, MS 38679 -0335
Phone: 865-228-2460	Phone: 662-838-4732
Email: easttnfoster at bellyrubs.org	Email: bellyrubsbr at bellyrubs.org
(replace "at" with @ and remove spaces)	(replace "at" with @ and remove spaces)