Minnesota Basset Rescue Adoption Application Form
We are excited that you are considering adopting one of our lovable hounds!
Please complete this form as thoroughly as possible so we can match you with a basset that is right for your family.


Minnesota Basset Rescue's Adoption Conditions
Please be aware that:
1. Reference checks are done on all adopting families.
2. We require the pets of adopting families to be current for rabies, distemper, and annual heartworm test and preventative.

I understand that MNBR will contact the vet(s) I list below to verify whether my current or former dogs and/or cats meet MNBR’s vaccination requirements listed above to be approved for adoption (Please only check applicable boxes) *
Required
APPLICANT INFORMATION
Name *
Your answer
Email Address *
Your answer
Address *
Your answer
City, State, Zip Code *
Your answer
Phone Number *
Your answer
Cell Phone Number
Your answer
Why do you want to adopt a basset?
Your answer
When do you plan to adopt?
Your answer
Name & tag # of dog you are interested in:
Your answer
HOUSEHOLD INFORMATION
Do you own or rent?
I live in a:
If you rent, will your landlord give you written permission to have a dog?
Landlord's Name:
Your answer
Landlord's Phone Number
Your answer
Number of Adults (over 18)
Your answer
Number of Children and Ages
Your answer
Is anyone in the family allergic to dogs?
Is someone home during the day?
If so, who?
Your answer
Is someone home at night?
If so, who?
Your answer
How many hours will the dog be home alone?
Your answer
Where will the basset be kept during the day?
Your answer
Where will the basset be kept during at night?
Your answer
Where will the basset be kept when no one is home?
Your answer
YARD
Do you have a fenced in yard?
If yes, what type? (wood, chain link, etc.)
Your answer
If my yard is not fenced in, I will keep the dog on leash at all times when outside.
If yard is not fenced, what arrangements have you made for exercise and toilet duties?
Your answer
If you have steps leading into your home, how many do you have?
Your answer
If you have steps inside your home, how many do you have?
Your answer
Which family member will be the basset's primary caretaker?
Your answer
DOGS AND YOU
Have you ever owned a dog before?
Type of dog:
Your answer
How long ago?
Your answer
Have you owned a rescue dog?
Have you owned a basset before?
Have you ever given up a pet?
If yes, what type and why:
Your answer
If you have had or presently have other pets in your family, please complete the following questions:
1. Pet's Name, Type/Breed, & Length of Ownership:
Your answer
Do you currently still own this pet?
Age
Your answer
Spayed/Neutered
Temperament
Behavior with other dogs?
Your answer
2. Pet's Name, Type/Breed, & Length of Ownership:
Your answer
Do you currently still own this pet?
Age
Your answer
Spayed/Neutered
Temperament
Behavior with other dogs?
Your answer
3. Pet's Name, Type/Breed, & Length of Ownership:
Your answer
Do you currently still own this pet?
Age
Your answer
Spayed/Neutered
Temperament
Behavior with other dogs?
Your answer
4. Pet's Name, Type/Breed, & Length of Ownership:
Your answer
Do you currently still own this pet?
Age
Your answer
Spayed/Neutered
Temperament
Behavior with other dogs?
Your answer
PREFERENCES
Do you have a gender preference?
Do you have an age preference?
Do you have a color preference?
Tell us more about the kind of basset you're interested in or describe your ideal dog:
Your answer
Are you willing to housetrain, if necessary?
Are you willing to work with a Minnesota Basset Rescue trainer if problems occur?
Are you willing to take the basset to obedience classes, if needed?
If necessary, are you willing to use a crate to confine your dog when no one is home to supervise?
Have you ever crate trained a dog?
Do you have a crate available?
Are you willing to allow an MNBR representative to visit your home prior to an adoption?
Comments
Your answer
BASSET HOUND CARE AND TRAINING
MNBR vaccine requirements: Rabies and distemper, annual heartworm test and preventive.
Please contact your veterinarian's office to let them know we will be calling
VETERINARIAN CARE
Do you have a regular vet?
Vet's Name/Clinic Name
Your answer
Phone number
Your answer
Address
Your answer
City, State, Zip Code
Your answer
Pet(s) Names on Vet records:
Your answer
Family Name on Vet Records:
Your answer
* Please note: your vet WILL be contacted to verify the vaccination status of all applicable family pets.
If you do not have a current or regular vet, please submit the names of two references (excluding family members).
Reference 1
Name & Phone #
Your answer
Reference 2
Name & Phone #
Your answer
ALL OF THE ABOVE AREAS MUST BE COMPLETED IN FULL
PLEASE READ ALL THE FOLLOWING CAREFULLY AND CHECK IF YOU UNDERSTAND & AGREE.
I UNDERSTAND I AM RESPONSIBLE FOR AND AGREE TO THE FOLLOWING.
My basset will need an annual heartworm test and preventative medication *
My basset will need an annual check-up and vaccinations. *
My basset will need regular grooming, nail trims, and ear cleaning, *
My basset will need regular exercise. *
My hound is a scent hound and must NEVER be left off leash in an unsecured area. *
My basset will not be allowed on a boat or near an unfenced pool without supervision. (Most bassets cannot swim due to their body configuration and could easily drown) *
The average cost for the first year to ‘outfit’ my dog (crate, bed, bowls, food, vet care & toys) could exceed $500. *
I understand that my basset hound is a house dog and is not to live or be kenneled/chained outside for an extended period of time. *
I have read, understood and agree to comply with the requirements of the MN Basset Rescue adoption stipulations and policies as listed here as well as in the Adoption Policy on our website. I authorize the verification of any and all information as provided on this form as it is, to the best of my knowledge, true and complete. I further understand that falsifying answers on this application or at any other time to an MNBR representative disqualifies me from adopting from MN Basset Rescue (MNBR). I am aware that submission of this application does not guarantee that I will be approved to adopt a dog from MNBR. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service