Oregon Basset Hound Rescue Adoption Application Form
A successful adoption depends on matching the selection of the right Basset for your household and our understanding of the dog’s individual needs. So that we may assist both parties with this selection process, please answer the following questions as completely as possible. The bold areas must be completed, if you are unsure on answering other areas,please leave a blank. The more completely you answer, the better we can match up dogs with homes.
Thank you.

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Name: *
ex: John Smith
Street Address: *
ex: 101 Main Street
City: *
ex: Keizer
State: *
ex: OR
Zip: *
ex: 97307
Home Phone: *
ex: 555-555-5555
Best hours to contact you? *
ex: 6-8 PM
Email address: *
Referred to us or found us via *
ex: web search
Do you have preferences about the Basset Hound you wish to adopt? *
If yes, you must give us some guidelines. Please list any specific preferences on th elines below (e.g. sex, color, age limits, etc.)
Plesae check the boxe(s) that best describe the Basset of your dreams. *
Have you ever owned a dog before? *
If yes, what breeds?
Have you ever owned a Basset before? *
Do you presently own any other animals? *
If yes, type what breed, sex altered and how long you have that animal.
Why do you want to own a Basset? *
Number of adults in your household? *
ex: 2
Number of children in your household? *
ex: 0
If you have children in the household, please list name and age of children
How do other members of the family feel about adopting a Basset Hound? *
Is anyone at home allergic to dogs? *
If so, why?
Are you willing to housetrain a dog if necessary? *
Check if you would like an inside, an  outside dog or check both if you want either. *
Do you own or rent your home? *
How long have you lived there? *
If renting, do you have written permission from the landlord to have a dog?
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Dwelling type: *
Backyard Dwellings
Bassets will wander off if they are not on a leash or behind a fence. If tied out, a basset
is miserable and your neighbors will hear about it. They usually do not return if they wander off.

Do you have a fenced area with shelter ready for a a dog? *
If yes, type in type of fence, length, width and height
Will someone usually be home with the dog during the day? *
Will someone usually be home with the dog during the night? *
Where will the dog be kept during the day? *
Where will the dog be kept during the night? *
Where will the dog be kept whe you are away from home? *
All dogs need to have shots or titers updated every year, with a rabies booster every third year. Arfe you established with a vet? *
If yes, type in the vet information.
May a rescue representative make a home visit prior to adoption? *
Is there anything else you feel you need us to know?
Signature(s) of Agreement
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. I also understand that there is a fee for adopting a rescue basset and it will help to cover health care and placement costs of needy bassets that find their way to this non-profit rescue service.

Signature(s) of Applications(s) *
ex: John Smith
Date: *
ex: 01/01/2012
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