Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Who were you referred by?
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Have you applied or adopted with NEBHR before? If so, when?
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Are you planning a move in near future?
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Do you own or rent your home?
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If renting, landlord name & phone number
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Dwelling type (single family, multi-family, condo, apartment)?
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Does home have stairs a dog would need to navigate daily? If so, please describe
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Do you have fenced yard? If yes, describe fence material and height
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Have you owned a dog before?
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What breed(s) have you owned?
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What pets have you owned in past 5 years?
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What happened to them?
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Have you ever surrendered an animal or put up for adoption? If yes, explain:
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How many cats do you currently have? What are their ages?
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How many dogs do you currently have? What breeds, sexes and ages?
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Are all pets spayed/neutered? If not, why?
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Do you plan to let your dog(s) have puppies?
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Do you plan to let your cat(s) have kittens?
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Are all current pets vaccinated? Which vaccines?
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Do you use monthly heartworm preventative? Which one?
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How long will your dog be left alone on an average day?
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Who will have primary responsibility for your dog's care?
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What do you anticipate spending on annual care for your dog?
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What is the reason you wish to adopt?
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Name & phone number of your local Animal Control Officer
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Have you ever had a pet impounded? If yes, please explain:
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How do you plan to address behaviorial problems such as excessive barking?
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How do you plan to address behaviorial problems such as excessive chewing?
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How do you plan to address housetraining issues?
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How do you plan to exercise your dog?
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What are your thoughts on off-leashing your dog?
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Are you prepared to allow at least a 2-week adjustment period?
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Are you willing to housetrain?
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Do you understand that a dog may be a 15-year responsibility?
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How many adults reside in your home?
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How many children under 18 years of age reside in or regularly visit your home?
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Ages and gender of children under 18:
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What are your family's feelings about adopting a Basset Hound?
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Do any family members have allergies to any animals? If yes, explain:
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Where will dog be kept at night?
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Where will dog be kept during the day?
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Where will dog be kept when no one is home?
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Name and phone number of current Veterinarian
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Are you willing to have a home visit as part of our approval process?
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What age dog do you prefer?
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What sex dog do you prefer?
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Is there a specific dog you are interested in?
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Have you submitted an application to other rescues/shelters? If yes, please indicate organization names
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Will you take responsibility for your dog for its entire life?
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Other comments that will let us learn more about your family, as well as what characteristics you're looking for in a dog
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By submitting this application, I/we agree that all the information provided is true and accurate to the best of my/our knowledge.
Please verify that you are human
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Submit
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