adoption application...
basset rescue of old dominion, inc.

 Basset Rescue Of Old Dominion
3445 Seminole Trail, Box 248
Charlottesville, VA 22911
Tel: 866-710-9476 (toll free)
email:

Please complete and send, along with your payment for $10 (Check or PayPal),
as directed at the bottom of this form.

Note that you must be 21 years old or older to apply.

NOTE: 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.

Please answer all questions.

Applicant First Name:

 

Last Name:

Co-Applicant First Name:

Last Name:

Address:
City:   

State:

Zip:

Home Phone:

 

Work 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. Thank you.

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 vet?  Yes   No

If yes, please provide veterinarian's name, address and phone number:

Vet's Name:

 
Address:
City:   

State:

Zip:

Phone:

 

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 other pets (birds, cats, etc) in the household?  Yes  No

If yes, please list:

Do you currently own  or rent your home?

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?  House  Apartment  Townhome  Condo  Trailer  Farm

Do you have a fenced area or yard for the dog?  Yes  No

If yes, what type of fence:

Are you willing to reinforce/repair your fence, if needed?  Yes  No

If no, how do you plan to exercise your pet?

Do you have neighbors who would be bothered by a barking dog?  Yes  No   

Have you ever taken a basic dog obedience course?  Yes  No   

Have you ever "adopted a dog"?  Yes  No

     If yes, from where? Check all  that apply:   

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

Are you willing to take your new Basset to the vet for a physical within 10 days of adoption?   Yes  No  
If necessary are you willing to:
House train your Basset? Yes  No
Take your Basset to obedience school? Yes  No
Purchase a crate and crate train your Basset? Yes  No
Do you understand that the Basset will :
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:
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
Do you know that before you adopt from BROOD:
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

What gender of dog are you looking for?   Male  Female  No Preference

What age of dog would you prefer?

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
Dog's 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
Other (please describe)

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:

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.

HOW DO YOU PLAN TO PAY THE $10 APPLICATION FEE?    Check  PayPal

FOR QUICKEST RESPONSE SUBMIT YOUR APPLICATION ONLINE Whether you intend to pay your application fee via check or with PayPal, clicking on the "SUBMIT" button ensures the quickest response. You'll have the opportunity to pay with PayPal after you click on SUBMIT. 

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.

             
Clicking on the SUBMIT button represents my confirmation of the statements above.

IF YOU CANNOT SUBMIT YOUR APPLICATION ONLINE If you are unable to submit this application online, please PRINT, SIGN and MAIL the completed application to the address at the top of this form, along with your check for $10 made out to BROOD.

With the 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 3.1-796.96:5 Subsection C, I/WE ALSO CERTIFY THAT I/WE HAVE NEVER BEEN CONVICTED OF ANIMAL CRUELTY, NEGLECT OR ABANDONMENT.

Signature:  _______________________________________________  Date: ___________
My signature represents my confirmation of the statements above.
 Note that mailing your application will result in a five to seven-day delay in processing.