First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone

Work Phone
x

Cell Phone*

Alt Email

How did you hear about us?*

Have you ever owned or lived with a dog before?

If so, what breed?*

Have you ever surrendered a pet?*

If so, please explain the circumstances*

Why are you interested in adopting a Basset Hound*

What age of Basset Hound are you interested in?*

What sex of dog do you prefer?*

Due to the unknown origin and history of some of the dogs we take in we won't always know if they're housetrained or not. Would you be willing/able to adopt a basset that is not or possibly not housebroken? Bear in mind that all dogs may regress a little when their environment changes. Please explain why this might be a major problem for you.*

Would you consider a Basset Hound mix?*

Are you interested in a particular hound on our website?*

Which hound are you interested in? If you don't have a particular dog in mind, or the dog you like is not in this list, you don't need to answer here. Our adoption liaison will contact you later to discuss a good match for you.
Choose an animal: Bella Buddy (Sacramento) Buzz Lilly (Red Bluff)

If the hound you are interested in is not listed above, or you are interested in more than one hound, please tell us here*

Where will the dog sleep at night*

How much time will the dog spend alone during the day*

How will you train the dog*

Is your yard fenced*

What is the height of the fence*

What type of fence*
Choose one: Privacy Chain Link Invisible

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home*
Choose one: Rent Own

If you rent, please enter your landlord's name and phone number. (This question is a required field, so if you own your home, just state "N/A").*

Landlord's name/phone number, if applicable (again, mandatory, so if you own your home, just state N/A)*

Please tell us about the current pets in your household. Choose the first answer that applies in this list, then see the next question - there you can tell us about your other pets. We need to know the breed, sex, age, spayed or neutered (if a dog), personality etc. This will help us make a good match for your current pets as well as for you!*
Choose one: None dog cat horse/large outdoor animal rabbit other small animals

Please tell us about the other pets in your home - species, breed, age, sex, spayed or neutered, personality etc. If you have dogs, how do they behave with other dogs.

How many people reside in your household*

Please give the actual ages of any minor children in your household. Do young children visit often? What are the approximate ages of the most senior adults in your household? Any infirmities or limitations in mobility? This information will help us to match the right hound for your household.*

Who in your household will be the main carer for the hound? How will other household members assist?*

Please give the name, address and phone number of your most recent veterinarian. We will call the vet office for a reference. (Please authorize your vet to discuss your vet records with GGBR). *

IMPORTANT: To help find your record, what name will the vet record be under? Please give the pet's name AND the human owner of record. If you have not had a pet within the last two years, please say so here.*

List TWO references (who are not a family member), please include CONTACT PHONE#*