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, Virginia and parts of Pennsylvania ONLY. We do not serve North Carolina, Tennessee, Ohio or Kentucky.

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

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 *

City *

County *

State * AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY -Terr.- AS FM GU MI PR VI

Zip *

Home Phone *

Work Phone

Cell Phone

E-mail Address: *

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?

Yes
No
N/A

Are you a previously approved BROOD foster or adopter? *

Yes
No

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 and how often will they visit?

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? *

If the dog will be left alone for longer than 7 hours, please describe in detail how your dog will be cared for (dog walker, dog door, etc.)

Do you plan to crate your dog? *

Yes
No

If yes, how long will the dog be crated each day?

Your home is currently *

Owned
Rented

Which most closely describes your type of home? * HouseApartmentHi-RiseCondoTrailerTownhomeFarm

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? *

Yes
No

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

Are you established with a veterinarian? *

Yes
No

Name of Vet or Vet Clinic/Hospital

Vet Street Address

Vet City

Vet State AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY -Terr.- AS FM GU MI PR VI

Vet Zip

Vet Phone

Vet Fax (A fax number is REQUIRED to process your application.)

Vet Email: (A fax number OR email 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? *

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 have previously 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

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 *

Are you willing to take your basset to a trainer or obedience school, if needed? *

Yes
No

Do you understand the following about your rescue basset?

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

Younger dogs require a higher amount of exercise and can be destructive? *

Yes
No

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

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 BROOD hound(s) you are interested in:

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

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

Verification Code:

Enter Verification Code: *

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