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 live in the TIDEWATER area of Virginia (near Norfolk) please contact Basset C.A.R.E. instead.

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

Applicant First Name *

Applicant Last Name *

Co-Applicant First Name

Co-Applicant Last Name

Street Address *

City *

State *

Zip *

Home Phone *

Work Phone

E-mail Address: *

Preferred means of contact *

Phone
Email

How did you learn about BROOD?

A successful adoption depends on both the selection of the right basset for your household and the understanding of his/her care-taking needs. So that we may assist you with this selection, please answer the following questions as completely as possible.

How many people are there in your household? *

Ages of minor children?

Approximately how long would the dog be left alone within a 24-hr period? *

Are you established with a veterinarian? *

Yes
No

Name of Vet or Vet Clinic/Hospital

Vet Street Address

Vet City

Vet State

Vet Zip

Vet Phone

Vet Fax

Have you ever owned a dog? *

Yes
No

Have you ever owned a basset hound? *

Yes
No

If yes, what happened to the dog, or any other dogs you have owned.

Do you have any pets (dogs, cats, birds, etc.) in the household? *

Yes
No

If yes, please list.

Have you ever adopted a dog? *

Yes
No

If yes, from where? (check all that apply)

City/County Shelter
SPCA
Humane Society
BROOD
Another Rescue Group
Private Shelter
Other

If you adopted from BROOD, when? (approximate date is ok)

What was the dogs name when with BROOD?

Have you moved since you adopted from BROOD?

Yes
No

Have you ever returned a dog that you adopted or relinquished a dog you owned?

Yes
No

If yes, what were the circumstances?

If yes, what was the name and city/state of the rescue group or shelter?

Your home is currently *

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.

What most closely describes your type of home? *

Do you have a fenced area or yard for the dog? *

Yes
No

If yes, what kind of fence?

Are you willing to reinforce/repair your fence, if needed?

Yes
No

Do you have a dog door? *

Yes
No

How much directed exercise will your dog get every day? *

What is your primary level of exercise with the dog? (check all that apply)

Yard (fenced) exercise
Short walks
Vigorous walks
Hiking/Jogging
Dog park

Where will your dog sleep? *

Do you have neighbors who would be bothered by a barking dog? *

Yes
No

ARE YOU WILLING TO ...
Take your new basset to the vet for a physical within 10 days of adoption? *

Yes
No

House train your basset? *

Yes
No

Take your basset to obedience school? *

Yes
No

Purchase a crate and crate train your basset? *

Yes
No

ARE YOU AWARE THAT BASSETS ...
Need to be checked annually for heartworm and put on heartworm preventative? *

Yes
No

Require routine and emergency veterinary care, including dental work? *

Yes
No

Need periodic grooming, to include brushing coat, trimming nails, and ear cleaning? *

Yes
No

Need plenty of exercise? *

Yes
No

ARE YOU AWARE THAT ...
Younger dogs require a higher amount of exercise and can be destructive? *

Yes
No

Young puppies (under 6 months) are rare and popular in rescue. If you want a puppy are you willing to be placed on a waiting list? *

Yes
No
Not interested in puppy

Rescue bassets are companion dogs and are to live inside your home and be an active part of the family? *

Yes
No

The basset hound is a scent hound and therefore must never be off leash in an unsecured area? *

Yes
No

The average cost in the first year to outfit your dog (leash, collar, dog bed, bowls, food and vet care) could exceed $1000? *

Yes
No

A volunteer will visit your house and meet with your entire family? *

Yes
No

You will pay an adoption fee and be required to sign a legal Adoption Contract? *

Yes
No

You may need to travel to the dog's location (MD, DE, VA, WV, PA) for adoption? *

Yes
No

Who will be primarily responsible for the care of the dog? *

If your dog has problems, what steps would you take before returning him/her to BROOD? (check all that apply)

Seeing a professional trainer or behaviorist
Calling the BROOD trainer and following her advice
Taking the dog to the vet for a medical evaluation
Purchasing equipment (such as the Thundershirt) that may alleviate the problem

Under what circumstances would you give up your dog? (please check ALL that apply)

We need to relocate
We have a baby
The dog requires expensive veterinary care
Someone in the family becomes allergic
Someone in the family becomes very ill
There is a divorce in the family
Dogs main caretaker leaves (for college, another job, called up for overseas duty, etc.)
Dog does not get along with other pets
Dog becomes incontinent or forgets housetraining
Dog has separation anxiety
Dog becomes aggressive towards a family member
Dog is aggressive toward strangers
Excessive barking
Excessive digging
Dog has too much energy
Excessive shyness/nervousness
Dog is food aggressive or resource guards
Other (please describe below)

Other reason(s) for giving up a dog

We ask these questions so that you will think about all of the aspects of bringing a dog into your family. Your response does not automatically cause you to be disqualified from adoption.

Do you have a close friend or family member who would be willing to provide long-term care for your dog if an emergency arose? *

Yes
No

Please use this space to provide any additional information you feel is pertinent.

How do you plan to pay the $10 application fee? *

Check
Credit Card
PayPal

Verification Code: Visual Verification Image

Enter Verification Code: *

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

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