Which Dog are you interested in? * Address Line 1 * Address Line 2 Town * State * Zip Code * Email * Phone # * Driver's License No. * Please specify if you have a color/breed preference and or personality type: Have you ever had pets before? * If YES, what kind? Do you currently have pets in the home? * If YES, what kind? Please list all pets that you have had in the past five (5) years:
List type (cat/dog), if they were spayed/neutered, licensed, vaccinated, where kept (outdoors/indoors), pet’s name, pet’s age, gender, and if they are living/deceased.
Please list name and telephone number of current or past vets used: By checking the box below, you are giving your veterinarian(s) authorization to release your pet(s) health records to BASS. * How did you acquire your pets? If applicable, name of shelter where you acquired your pets: If you do not currently have a pet(s) and have not had a pet(s) in the last 5 years, please provide the name and phone number of two references who would have knowledge of your relationship with past pets or your interaction with the pets of others: Do you currently live in: * If renting, does your lease allow pets? How long have you lived at your present address? * Landlord's name and phone number if you rent, or Association's Name & Phone No. if you live in a condo or townhouse: How many people live in your household? *
Please list ages of all children
Do all adults know that you plan to adopt? * Do any of the persons listed above have allergies? * If yes, please explain Are you financially prepared to give your pet both routine care, such as vaccines, exams for parasites, ear mites, blood testing, etc. when needed, as well as emergency care which could be over $500? * If NO, please explain Do you understand that BASS cannot make guarantees as to the animal’s temperament, health or training? * Are you aware that by adopting a young pet, you are making a 15-20 year commitment: * If NO, please explain If no, explain If you were no longer able to care for your pet(s), what would you do with your pet(s)? * Have you ever lost or given away a pet? * If YES, why? How many hours a day will your pet spend indoors/outdoors? *
Please specify times for both indoor and outdoor
Where will your pet be kept during the day? * Where will your pet be kept at night? * How did you hear about our adoption services? * Did you adopt from us before? * If yes, when? what? where is pet now? If you were moving to a residence that did not allow pets, what would you do with your pets? * Do you want your new pet for a (check all that apply) * If other, please explain: Would you object to a visit from a BASS representative either before or after an adoption? * How will you keep your dog confined to your property: (check all that apply) * If Other, please explain Do you have a fenced yard? * Single If yes, how high? What will you do if your dog chews furniture? BY CHECKING BELOW, YOU CERTIFY THAT YOU HAVE READ, UNDERSTAND AND ACCEPT THE TERMS BELOW: