BHRG * P.O. Box 680322 * Marietta, GA * 30068-0006 * 770.499.1164

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All fields with a * are required.

*Name
	(please include the name of your partner or spouse, if applicable)
Name of Parent or Guardian
	(if under age 18)
*Address
*City
*State	Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
*Zip
*Home Phone
Work Phone
Work Hours	From    To
Cell/Pager
*E-mail

*Please tell us how you heard about BHRG?	Select One Web Search Engine Link from Another Website Friend or Family Veterinarian Animal Shelter PETsMART Newspaper or Magazine Other
So we can determine which advertising works best, please give more specific information about how you heard of BHRG.

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A successful adoption depends on both the selection of the right Basset for your household and the understanding of his/her caretaking needs. So that we may assist you with this selection, please answer the following questions as completely as possible. Thank You.

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*Do you own or rent your home?	OwnRent
*Type of dwelling	House
	Condo
	Apartment
	Mobile
*How long have you lived at your current address?	Select One Less than 1 year 1 to 5 years 6 to 10 years More than 10 years
Leasing Manager Approved?	YesNo
Leasing Manager's Name
Leasing Manager's Phone Number
Parent(s)/Roommate(s) Approved?	YesNo
Parent(s)/Roommate(s) Name
Parent(s)/Roommates(s) Phone Number

*Do you have a fenced-in yard for the dog?	YesNo
What type of fence is it? Check all that apply.	Chain Link
	Privacy
	Picket
	Invisible
	Attached
	Not Attached
	Dog Pen
	Dog Run

Fence Dimensions
Length	Width	Height

*Do you have a pool, pond or hot tub in your yard?	YesNo
If yes, is there a fence around it?	YesNo
Are you willing to reinforce or repair your fence if needed?	YesNo
If no fence, what arrangements will you have for the dog's exercise and toilet duties?

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*Have you ever owned a pet before?

YesNo

What happened to your previous pets?

*Have you ever owned a basset hound before?

YesNo

*Do you presently have other animals?

YesNo

	Please complete the following for each of your current pets.

Pet's Name	Type (dog, cat...)	Breed	Gender	Spayed/ Neutered	Age	Years Owned	Next Shots Due (MM/DD/YY)	Type of Heart- worm Prevention

Please tell us why any of your pets are not spayed or neutered (if applicable).

*Are you established with a vet? YesNo Vet Clinic Name? Vet Clinic Phone Number?

*How much do you expect to spend on veterinary expenses in a year?

*In comparison to other breeds of dogs, in your opinion, bassets need:

More Attention Same Amount of Attention LessAttention

*The best traits of a basset are? *The worst traits of a basset are? *How will the basset fit into your lifestyle?

*I have trained dogs before and will train this one myself. YesNo

*I have knowledge to take a "problem dog". I will take a dog with the following problem(s).

House Breaking   Chewing   Lacks Manners   Needs Socialization   Possibly Abused   None Of the Above

*I am prepared to take resposibility for a dog for its lifetime. YesNo

What is your occupation?

*Number of Adults in Household? Select One 1 2 3 4 More Than 4   *Number of Children in Household? Select One None 1 2 3 4 More Than 4

Ages and genders of children?

How do other family members feel about adopting a basset?

*Is anyone home during the day? YesNo *At night? YesNo

*Where will the dog be kept during the day? *At night? *When you're away?

*Is anyone allergic to dogs? YesNo

*Tell us your preferences for your adopted basset... Age? Color? Gender? Other?

*Will you consider adopting a bonded pair of bassets? YesNo

*Are you willing to have a home visit done prior to adoption? YesNo

NOTE: A PRE-ADOPTION home visit is REQUIRED for all applicants outside the metro-Atlanta area and may be required otherwise as determined by BHRG.

OUT OF STATE APPLICANTS ONLY:
Did you contact your area rescue prior to completing this application?	YesNo

Name of Rescue Organization

IN STATE APPLICANTS ONLY:
*Would you be interested in becoming a foster home for BHRG?	YesNoN/A (I'm from out-of-state)

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If you are planning to attend an adoption event, PLEASE PRINT THIS PAGE before submitting it and bring it with you to the adoption. Otherwise, you may be required to complete another application at the adoption event. When you click the SUBMIT button, your application will be submitted to the BHRG Adoption Coordinator.

By submitting this form, you agree to the following statement: 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.

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Please click this button only once.

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[ Home |

BHRG & Basset Info |

Adoption |

The Dogs |

Success Stories ]

[ Volunteer |

Help Us |

BHRG Gear |

Links |

Thank Yous |

Contact Us ]