Cosmic Basenji Application

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Feel Free to provide as much detail as possible in order to get to know you better!!

Email *

Name

Phone Number

Location - City/State *

Occupation *

Why are you interested in getting a basenji *

Prior Ownership *

I have never had any pets before

I have never had dogs but have had pets

I have never had basenjis but I have/had other breeds

I have had basenjis before but don't currently any

I currently have other basenjis

Other:

How many years of Basenji experience do you have? *

1-5

5-10

10-20

20+

List all household members and ages *

Caretaking responsibilities *

I will be the main caretaker

I will be the main caretaker but other adults in the home will assist in care

I will be the main caretaker but children in the home will assist in care

My child will be the main caretaker

Other:

Do you have any regular guests that do not live in the home. Will they be involved with care/training? *

Please describe all household members daily/weekly schedules. (work, school, etc) Please include how long and when the dog would be alone. *

Where do you plan to keep the dog when you are home, at work, asleep, etc.? *

Housing *

Rent

Own

Dwelling *

House

Apartment

Duplex

Townhome

Other:

Yard/Property size

No Yard

0-5k Sq Ft

5k-15k Sq ft

15-30k Sq ft

1-5 Acres

5-20

20+

Other:

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Fencing *

No Fencing

Back yard is partially fenced

Back yard is fully fenced

Property is fully fenced (Front and Back yards)

Other:

Please provide any additional details you would like me to know regarding the property (yard, fencing etc) where the dog will be residing.

Provide details about your past pets *

Include animal type/breed/sex/age and why they are no longer in your care.

Provide details about ALL of your current pets *

Include animal type/breed/sex/age

Provide details about anything else that you think I should know

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