BROOD serves as a safety net for adoptable Basset Hounds in shelters. Our intake capacity is limited, and we ask that every effort be made to adopt the dog locally before contacting BROOD. BROOD can no longer automatically accept every dog; each will be taken in on a case by case basis.

This Shelter Referral Form must be completed for all dogs prior to a final intake decision being made and prior to the dog being physically removed from a shelter by a BROOD volunteer. All intake decisions are solely made by the BROOD Intake Committee.

If you have any questions about BROOD’s policies or our process, please contact the intake committee BEFORE you submit the Shelter Referral Form.

Name of Dog

Dogs ID Number

Shelter Name *

E-mail Address: *

Street *

City *

State *

Zip

Phone *

Fax

Days and Hours Shelter is Open *

Shelter Contact Name *

Position *

Your Name

Your Email

Date the dog arrived in shelter *

The dog was a *

Stray
Owner Relinquishment

Date mandatory stray hold is up

If owner relinquishment, why was the dog relinquished?

If owner relinquishment, what is the shelter hold policy? (e.g., 5 business days)

Is this dog scheduled for euthanasia? *

Yes
No

If yes, indicate date

What is the dogs age? *

Dogs age group? * Puppy (under 6 months)Juvenile (6 months – 2 years)Young Adult (2 – 4 years)Adult (4 – 7 years)Adult (7 – 10 years)Senior (over 10 years)

Check the Breed Description that Best Applies * Purebred classic bassetPoorly bred basset or possible mixDefinite mixPurebred of another breed (beagle, etc.)

Gender? *

Male
Female

Neutered/Spayed? *

Yes
No
Not Sure

Housetrained? *

Yes
No
Partially
Not Sure

Does this dog appear healthy? *

Yes
No (describe below)

If no, please describe health issues

Vaccinations? *

Rabies
DHLP
Bordetella
None

Any signs or record of aggression toward humans? *

Yes
No

If yes, please describe

Does the dog get along with cats? *

Yes
No
Not Sure

Other dogs? *

Yes
No
Not Sure

Children? *

Yes
No
Not Sure

Describe the dogs basic temperament (check all that apply) *

Friendly/Playful
Friendly/Laid Back
Timid/Shy/Fearful
Withdrawn/Depressed
Aloof
Aggressive
Pushy/Dominant
Submissive

Any other pertinent information

Has a photo of the dog been submitted? *

Yes
No

If no, please attach a photo of this dog

Name of Other Rescue Group Involved (if applicable)

Rescue Group Contact Name

Rescue Group Email

Rescue Group Phone

Verification Code:

Enter Verification Code: *

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* Required