BROOD Adoption Application

Please complete this form and submit it ONLINE regardless of how you intend to pay the application fee. You must be 21 years old or older to apply. After you complete and submit this form you will see information about submitting your non-refundable application fee for $10 (Check, Money Order or Paypal). If paying by Check, print out the form using the "Print" button at the bottom of this form before you submit it and mail it with your check. No adoption fees will be refunded after seven calendar days.

BROOD adopts dogs to residents of Maryland, West Virginia, DC, Delaware, most of Virginia and parts of Pennsylvania ONLY. We do not serve North Carolina, Tennessee, Ohio or Kentucky.

If you have any questions, please contact our BEFORE you submit your application.

PART I - APPLICANT INFORMATION

Home Phone
Work Phone
Cell Phone
Email
Yes
No
N/A
Previous BROOD Adopter or Foster
I am a BROOD Member
Facebook
Internet Search
BROOD Website
Newspaper
Attended BROOD Event
Saw BROOD at an Event
Friend, Relative or Neighbor
Animal Shelter/Other Rescue Group

PART II - ABOUT THE HOUSEHOLD

Yes
No
I haven't discussed it with them yet
Yes
No
Very quiet: only a few residents and not too many guests
Average: not too quiet, but not party animals either
Very busy: lots of people coming and going
Owned
Rented

IMPORTANT: If you rent you MUST have proof of your legal ability to keep a dog (i.e., a copy of your lease, written letter from the landlord, tenants association or rental office, etc.) available for inspection when your home visit is performed.

Yes
No
Yes
No

PART III - PET OWNERSHIP HISTORY

Yes
No

A fax number is required to process your application. Please contact your vet if necessary. Please enter "none" if you are not established with a vet.
Never
Once a year for an annual exam
Only for emergencies
A few times a year for exams, dentals and other necessary health care
I have never owned a pet
Yes
No
N/A (don't have a dog)
Yes, I do now
Yes, I have personally owned a dog in the past
Yes, my family has had a dog
No, I have never owned a dog
Yes
No
Dominant
Submissive
Possessive
Friendly
N/A (don't own a dog)
Active
High Energy
Laid Back
N/A (don't own a dog)
Yes
No
Yes
No
Yes
No
N/A (don't own a cat)
Aloof, ignores dogs
Does not get along with dogs
Playful with dogs
Aggressive toward dogs
Unknown, my cat has not been around a dog
Yes
No
City/County Shelter
SPCA
Humane Society
BROOD
Another Rescue Group
Private Shelter
Other
Yes
No
Yes
No
Yard (fenced) exercise
Short walks
Vigorous walks
Hiking/Jogging
Dog park
Yes
No

PART IV - BASSET BREED CHARACTERISTICS

Yes
No
Yes
No
Yes
No
Dominance
Stubbornness
Destructive chewing
Escape attempts
Jumping on people
Digging
Playing too rough
Leash pulling
Taking food from table or children
Aggression
Nervous or shy
Aloof
Too energetic
Not good with other pets
Noisy
Overly Protective
Shedding
Yes
No

Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

PART V - BASSET PREFERENCES

Basset mix
Senior dog
Dog with special needs
Bonded pair

PART VI - APPLICATION SUBMISSION

Yes
No
Check
Credit Card
PayPal

As part of the adoption process, BROOD has an agreement with PetHealth, Inc. and 24PetWatch to provide microchips and an option to purchase one year of insurance at a discounted rate for our adopted dogs. With these services, you will be eligible receive emails from them about the microchip registration and insurance program, which requires you to opt-in to receive these notices via email.

Yes
No
Yes
No
Visual Verification Image

All the information I have provided on this application is, to the best of my knowledge, true and complete. I understand that falsifying information on this application, or at any other time during the adoption process, disqualifies me from adoption. I am aware that submitting my application does not guarantee that I will receive approval to adopt a dog from BROOD and that BROOD reserves the right to reject any applicant at any time during the adoption process. I also understand that the $10 application fee is non-refundable.

With the electronic submission of this application form, I am authorizing BROOD to contact my veterinarian to discuss my veterinary records.

AS REQUIRED BY THE CODE OF VIRGINIA, CHAPTER 787 3.1-796.96.C.3, I/WE ALSO CERTIFY THAT I/WE HAVE NEVER BEEN CONVICTED OF ANIMAL CRUELTY, NEGLECT OR ABANDONMENT.


     
* Required Responses