Print out application, fill out, and mail with application fee to address listed on bottom of application.
Name and Age of Each Adult in Household: _____________________________________________________________________
Address __________________________________ City __________________ State ____
Zip __________
Phone: (H) _____________________ (W) _____________________ Email: __________________________
1. In what type of housing do you live? Apt/Condo _____ Townhouse _____ Single
Family _____
2. Do you: Own?____ Rent?_____ If renting, does landlord permit dogs? Yes____
No____ Not sure____
Is there a size/weight limitation on allowable dogs? Yes_____
No_____
If renting: Landlord’s name ____________________________________ Phone
_______________________
3. Do you have a fenced-in yard? _________ Description of fence and yard: ___________________________________
4. Number in household: Adults _______ Children _______ Ages of children: _________________
5. Does anyone in the household have allergies? _________ If yes, describe:
_________________________
6. Which family member will have major responsibility of caring for the dog?
__________________
7. How many hours a day will the dog normally be left alone? ____________________
8. How close is your nearest neighbor? ________________
9. Will this be your first pet? _____ What pets did you previously own? _______________________________
What happened to them? ___________________________________________________________________
What pets do you currently own? Dogs ______ Cats ______ Other ______ (please
list) __________________
If you currently own a dog, is it neutered/spayed? ____What breed?_______________
Age?_____ Sex?____
10. Who is your veterinarian? (Name/telephone) ___________________________________________
What pet name & last name are your vet records under? _____________________________________
11. Why do you want to adopt a Basset Hound? _______________________________________________
________________________________________________________________________________
12. What sex do you prefer? Male _____ Female _____ Age preference? ______________________
13. Do you agree to have your Basset Hound spayed/neutered if not already done?
_______________
14. Where will your Basset Hound spend most of its time? ___________________________________
15. Do you agree to return your Basset Hound to us if you are unable to keep
it? __________
16. Are you willing to provide us with follow-up reports? ______________
17. How were you referred to Tri-State BH Rescue? ____________________________________
18. When will you be ready to adopt?___________________________________
Signature: (All adult members of household must sign) __________________________________________________
_____________________________________________________________ Date: __________________
A MINIMUM DONATION OF $200 ($150 UNTIL FEBRUARY 28, 2006) IS REQUIRED, payable at time of adoption. The adoption fee is tax deductible to the fullest extent allowed by law. All dogs are spayed/neutered, inoculated and heartworm tested prior to adoption. Mail completed application to: Tri-State Basset Hound Rescue, Inc., c/o Sandy Gera, 10 Whitetail Drive, Chadds Ford, PA 19317. If you do not hear from us, please call Sandy Gera or Bob Arnold at 610-388-2434, weeknights from 6:30 - 9:00 pm to follow up. DOGS WILL BE PLACED WITHIN THE NJ, NY AND EASTERN PA AREAS.