Online Adoption Application

A $15.00 non-refundable adoption application fee is required. Carolina Basset Hound Rescue bassets require an adoption donation for dogs to assist in deferring veterinary costs. The adoption donation for puppies 10 wks. to 6 months is $350, dogs 6 months to less than a year $300, dogs one year old through 8 years old $250, and $150 for dogs older than 8 years or special needs dogs. All dogs placed by CBHR have received appropriate vet care as recommended by a CBHR vet. CBHR only adopts dogs within the Carolinas.

Please provide the following information:

Adults in household

1) First name: Last name:

2) First name: Last name:

Children in home

How many: Ages:

Street Address:

City: State: Zipcode:

Home phone: Area Code Phone prefix phone number

Cell Phone 1: Area Code Phone prefix phone number Notes:

Cell Phone 2: Area Code Phone prefix phone number Notes:

Work phone: Area Code Phone prefix phone number

E-mail:

E-mail 2:

Employer:

Occupation:

Employer 2:

Occupation 2:

A successful adoption depends on both the selection of the right basset 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:

What type of housing?

House Duplex Condo Apartment Modular Home

Do you rent or own?

Rent Own

If you rent or lease, do you have permission from your landlord to keep a basset indoors?

Yes No

Landlord's Name: Contact Number:

Do you have a yard?

Yes No

Is it fenced?

Yes No

Type of fencing: Fence Height:

If you don't have a fence, where and how will the dog be exercised and allowed to use the bathroom?

Are you a previous dog owner?

Yes No

Which breeds have you owned?

What other types of animal(s) live in your home? Please list breed, age, and how long you've owned them.

What do you know about basset hounds as a breed?

How do your family members feel about adopting a dog? And why has your family chosen a basset hound?

Is anyone home during the day?

Yes No

Is anyone home at night?

Yes No

Are you willing to crate train if needed?

Yes No

If no, please explain.

Is anyone in the house allergic to pet dander?

Yes No

If yes, who?

Where will the basset be kept during the day?

Where will the basset be kept at night?

Where will the basset be kept when you're away from home?

Would you consider a "Special Needs" basset such as one that requires daily medication, one who needs obedience training, one who is deaf, etc?

Yes No

Are you familiar with vet costs such as annual shots, routine care and/or unexpected expenditures?

Yes No

Are you aware of the importance of YEAR ROUND Heartworm preventive and Flea Treaments?

Yes No

If no, please ask your vet or a CBHR volunteer for more information. Negating these treatments and preventatives from your dog's routine can lead to sickness and the possible death of your pet.

Are you willing to allow a CBHR volunteer to conduct a follow up contact after the adoption?

Yes No

If no, please explain.

Please provide the following veterinary information.

If you have not owned a pet in the past two years, please provide a personal reference not related to you. (Provide personal reference ONLY if you have not owned a pet in the last two years.)

Name of Vet or Reference:

Name of Vet Clinic if applicable:

Street Address:

City, State and Zipcode:

Phone:

Release of veterinary Information

I authorize any veterinarian or veterinarian hospital/professional/kennel to furnish or discuss with any representative of CBHR all records in their possession regarding the care of their animals past or present. This information will be used in the adoption process of one or more dogs in the care of CBHR. I understand this authorization shall remain valid for one year after the date it is submitted. Upon presentation of this document, a photocopy or facsimile of same, you are directed to permit the personal review with a CBHR representative of any and all vet/kennel records.

I agree to the above terms of release.

Yes No

(Without this agreement, this information cannot be secured and the application cannot be processed.)

All of the information I have provided on this application is, to the best of my knowledge, true and complete. I understand falsifying answers on this application, or at any other time during the adoption process, will disqualify the household I represent from adopting a basset from Carolina Basset Hound Rescue (CBHR).

I understand that submitting an application is no guarantee that I will receive a CBHR basset. I further understand that placement of these bassets is at the sole discretion of CBHR and a reason for rejection of an application need not be given. Upon completion and signing of this application and release of any veterinary information, I wish to be considered for ownership of a CBHR basset.

I understand that if I do adopt a basset from CBHR, that should I choose not to keep the basset for any reason that it MUST be returned to CBHR. I also understand that if I do adopt a basset from CBHR, CBHR reserves the right to remove the basset from my home if it is believed that the basset is not being taken care of according to CBHR policies put forth.

I agree to the terms stated above.

Yes No

Comments

As a final question, we would like to know how you heard about Carolina Basset Hound Rescue.

The $15 adoption application fee can be paid by PayPal or by check or money order. Payment information will appear on the next page.