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 as completely as possible. Thank you.

Do you own or rent your home? Own Rent

Type of dwelling: House Condo Apartment Mobile Home

Do you have a fenced in yard for the dog? Yes No

Yes: Fence type:

Length Width Height

No: What arrangement will you have for the dogs exercise and toilet duties?

Have you owned a dog before? Breed(s)

How many years did you have it?

Have you owned a basset before? Yes No

Do you currently have pets Yes No

If yes, what kind and how many?

How many adults in household? Children?

Ages and sex of children

How do family members feel about getting a basset?

Is anyone home during the day?

Is anyone in the home allergic to dogs?

Are you willing to housetrain the dog if necessary? Yes No

Where will the dog be kept during the day?

At night?

When you are not at home?

Are you established with a vet? Yes No

Vet Clinic Phone number

Whose name is your pet records under at the Vet Clinic?

What are your Pets Names at the Vet Clinic?

Permission granted to MBR to call your vet for pet records? Yes No No Vet

If not, please provide details of how the medical needs of pets in your care will be met.

Are you willing to have a home visit prior to adoption? Yes No

Please tell us your preferences for your adopted basset.

Age        Any Age Puppy Young Adult Senior

Color     Any Color Tri-color Red & White

Sex        Either Male Female

Do you have any additional comments or questions?