Name & Age of Each Adult in Household*
In what type of home do you live*
Do you own or rent your home*
If you rent, have you received the approval of your landlord to have an animal*
Is there a size/weight limitation on allowable dogs?
If you rent, please enter your landlord's name and phone number*
Is your yard fenced*
Yard Partially Fenced
Yard Completely Fenced
What type of fence*
What are the ages of the children in your home?*
Does anyone in the household have allergies?
Please describe the allergies
Who in the household will care for the pet*
How much time will the animal spend alone during the day*
How close is your nearest neighbor?
Will this be your first pet?*
What pets did you previously own?
What happened to them?
What pets do you currently own?
If you currently own a dog, is it neutered/spayed?*
What is the breed, age and sex of your current dog?
Please tell us the name(s) of your current dog(s)
Veterinarian's Name and Phone Number **Please notify your vet practice that someone from Tristate will be calling them, and provide your authorization for the practice to talk to the screener.*
Why do you want to adopt a basset hound?
What sex do you prefer?*
Do you agree to have your Basset Hound spayed/neutered
if not already done?*
Where will your Basset Hound spend most of its time?*
Do you agree to return your Basset Hound to us
if you are unable to keep it?*
How were you referred to Tri-State Basset Rescue?
When will you be ready to adopt?*
Signature: (type in signature(s)
Additional Info and/or Comments: *
A FEE OF $300 FOR ONE DOG OR $430 FOR A PAIR IS REQUIRED, payable at time of adoption. Tri-State Basset Hound Rescue can not guarantee the breeds of any mixed breed dog. All dogs are spayed/neutered and inoculated prior to final adoption. Adult dogs are also heartworm tested prior to final adoption. Tri-State Basset Hound Rescue reserves the right to deny any application. If you do not hear from us, please email Dana Mania at
to follow up.
Tri-State Basset Hound Rescue
© 2019 Tri-State Basset Hound Rescue, All Rights Reserved.