SECTION I - APPLICANT INFORMATION
Applicant First Name *
Applicant Last Name *
Co-Applicant First Name
Co-Applicant Last Name
Who will be primarily responsible for the care of the dog? *
Street Address *
Home Phone *
Preferred means of contact * Home Phone Work Phone Cell Phone Email
If you are applying from a state other than DC, VA, WV, MD, DE or Southern PA, have you contacted the basset rescue in your state?
We encourage you to apply with them first. Please check this site for a basset rescue in your area. Yes No N/A
Are you a previously approved BROOD foster or adopter? * Yes No
SECTION II - ABOUT THE HOUSEHOLD
How many people are there in your household? *
Are all the members of your household in agreement about adopting a dog? * Yes No I haven't discussed it with them yet
Ages of minor children?
Are there other children who visit frequently? (grandkids, babysitting, etc.) * Yes No
If yes, what are the visiting children's ages?
Which most closely describes your household's activity level? * 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
Approximately how long would the dog be left alone within a 24-hr period? For periods longer than 7 hours, please describe in detail how your dog will be cared for (dog walker, dog door, etc.).
Your home is currently * Owned Rented
Which most closely describes your type of home? *
House Apartment Hi-Rise Condo Trailer Townhome Farm
Do you have a dog door? * Yes No
Do you have a fenced in yard? * Yes No
If you do not have a fence, where and how will the dog be exercised and allowed to use the bathroom? Do you agree to keep the basset on a leash when outdoors?
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
SECTION III - PET OWNERSHIP HISTORY
Are you established with a veterinarian? * Yes No
Name of Vet or Vet Clinic/Hospital
Vet Street Address
Vet Fax (A fax number is REQUIRED to process your application.)
Under what name is your vet account listed?
How often does your pet(s) see the 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
If you currently own a dog, is it on heartworm preventative and/or are you following your vet's recommendations for administering heartworm testing and preventative? * We will contact your vet to verify. BROOD requires that existing dogs be on heartworm preventative in order to adopt.
Yes No N/A (don't have a dog)
Have you ever owned 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
Have you ever owned a basset hound? * Yes No
If yes, what happened to the dog, or any other dogs you have owned.
Describe the temperament of dog(s) you currently own. (check all that apply) * Dominant Submissive Possessive Friendly N/A (don't own a dog)
Describe the activity level of dog(s) you currently own. (check all that apply) * Active High Energy Laid Back N/A (don't own a dog)
Why do you want to adopt a basset?
Do you have any pets (dogs, cats, birds, etc.) in the household? * Yes, I have pets now No, but I owned pets in the past 12 months No, but I have owned pets in the past (more than a year ago) No, I have never had pets
If yes, please list names, types and ages of all pets.
Do you currently have a cat or cats? * Yes No
If yes, have your cat(s) ever been around a dog? * Yes No N/A (don't own a cat)
What is your cat's attitude toward dogs? (check all that apply) Aloof, ignores dogs Does not get along with dogs Playful with dogs Aggressive toward dogs Unknown, my cat has not been around a dog
What would you do if your cat did not get along with a new dog?
Have you ever adopted a dog? * Yes No
If yes, from where? Please provide name, address, phone and contact name (if known).
If you adopted from BROOD, when? (approximate date is ok)
What was the dog's 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? Please provide name, address, phone and contact person's name (if known) of the agency to which the dog was returned.
How much directed exercise will your dog get every day? *
What will be 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 or howling dog or one experiencing separation anxiety? * Yes No
SECTION IV - BASSET BREED CHARACTERISTICS
Do you agree to take your new basset to the vet for a physical within 10 days of adoption? * Yes No
Are you willing to house train your new basset? * Yes No
Would you be able to tolerate accidents in the house while your adopted basset adjusts? (This is common even with housetrained dogs.) * Yes No
Please rate your ability/experience training dogs, including housetraining, basic manners like sit and come when called, and on retraining for dogs with problem behaviors such as chronic barking or chewing. (Pick the choice below that most closely matches your experience level.) * No experience. I do not have a lot of experience, but am willing to attend training classes to learn more. Limited experience. I have experience training my own dog(s) to be housebroken and with basic commands, but have not attended obedience classes OR I have attended only a puppy socialization class. Experienced. I have housetrained multiple dogs and attended obedience classes, and feel comfortable with housetraining and providing basic manners training for a new dog. Advanced experience. In addition to the above, I have successfully worked with a dog with a serious or chronic behavior problem such as separation anxiety, chronic barking, fearfulness or aggression.
What traits or behaviors would you be unwilling to handle or work through training with your new dog? (check all that apply) * Dominance Stubbornness Destructive chewing Escape attempts Jumping on people Digging Playing too rough Leash pulling Taking food from table or children Aggression Nervousness or shyness Aloofness Too energetic Not good with other pets Noisy Overly Protective Shedding Drooling Other (explain below) None
For any traits selected above, please describe what potential actions you would take to resolve the situation and under what circumstances you would consider returning the dog. If you selected "None" enter N/A.
Are you willing to take your basset to a trainer or obedience school, if needed? * 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
DO YOU AGREE THAT ... 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
SECTION V - BASSET PREFERENCES
Would you consider adopting: (check all that apply) Basset mix Senior dog Dog with special needs Bonded pair
What are your specific preferences for a dog? (age, gender, personality, energy level, etc.)
Name(s) of hound(s) you are interested in:
Other comments for the adoption team
SECTION VI - APPLICATION SUBMISSION
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
With your 24PetWatch microchip for your adopted BROOD dog, 24PetWatch offers
you free lost pet services, as well as exclusive offers, promotions and the
latest information from 24PetWatch regarding microchip and insurance
Pethealth Services (USA) Inc., Pethealth Services Inc, PTZ Insurance
Services Ltd. and PTZ Insurance Agency Ltd may contact you via commercial
electronic messages, automatic telephone dialing systems,
pre-recorded/automated messages or text messages at the telephone number
provided above, including your mobile number. These calls or emails are not
a condition of the purchase of any goods or services.
You understand that if you choose not to provide your consent, you will NOT
receive electronic enrollment notification regarding the trial/gift/voucher
of insurance and/or free LOST PET SERVICES which includes being contacted
with information in the event that your pet goes missing. You may withdraw
your consent at any time.
Do you consent to receiving notices from Pethealth Services, including
notifications when your pet is lost? * Yes No
Would you like to opt into the Petco Pals Rewards program to get rewards on purchases, special savings and members-only emails and offers for your new pet? * Yes No
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