Name's) of Applicant's):
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Fax Phone:
Email address:
Have you owned a dog before?	Yes No
If so, what breeds:
What happened to the dog's)?
What qualities are you looking for in a companion pet?
Describe what you know about Basset Hounds and their health/behavior
As a reference please give your vet's name and phone number :
Age preference:	From years old To     years old
I am looking for a ?	No Preference Male    Female
I am willing to housetrain a dog.	Yes    No
Rescued Bassets often have housetraining problems when adjusting to their new homes. How would you deal/handle this?
Do you have children in your home?	Yes   No
If so, what are their ages?
Do all members of the family want to adopt a basset hound?	Yes No
If not, please explain:
I live in a	House Condo         Apartment Mobile Home
Is the house: one story or two story?	1 Story   2 Story   Other
If you live in a two story house, how do you plan to keep the Basset downstairs to preserve its back/spine?
If Condo or Apartment	Upstairs Downstairs/One Story Two Story
Is property completely fenced?	Yes No              Partially
Do you have a doggy door?	Yes  No
Do you have a pool?	Yes  No
If yes, is it fenced?	Yes  No
Where will the dog be kept during the day?
Where will the dog sleep night?
Are you interested in fostering?	Yes No  Perhaps, tell me more
Have you had an opportunity to research Basset Hounds?	Yes No

We have the following pets living with us now

Pet Name	Breed	Altered	Sex	Age
		Yes   No	Male   Female
		Yes   No	Male   Female
		Yes   No	Male   Female
		Yes   No	Male   Female

 
How did you learn about Basset Hound Rescue of Southern California?