"*" indicates required fields Step 1 of 2 50% Full Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Email* Home Phone*Work PhoneCell PhoneAlt Email Text / Pager Email Name & Age of Each Adult in Household*In what type of home do you live*Single FamilyDuplexApartmentTownhouseCondominiumMobile HomeMilitary HousingOtherDo you own or rent your home*RentOwnOtherIf you rent, have you received the approval of your landlord to have an animal*YesNoN/AIs there a size/weight limitation on allowable dogs? Yes No If you rent, please enter your landlord's name and phone number*Is your yard fenced*No YardUnfenced YardYard Partially FencedYard Completely FencedOtherWhat type of fence*PrivacyChain LinkInvisibleNo FenceOtherWhat are the ages of the children in your home?*Does anyone in the household have allergies? Yes No Please describe the allergiesWho 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?* Yes No What pets did you previously own?What happened to them?What pets do you currently own? Dogs Cats Birds Others If you currently own a dog, is it neutered/spayed?* Yes No 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?* Male Female Either Do you agree to have your Basset Hound spayed/neutered if not already done?* Yes No 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?* Yes No How were you referred to Tri-State Basset Rescue?When will you be ready to adopt?*Signature: (type in signature(s)DateAdditional 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. Δ
