First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone

Alt Email

What is your dog's name?*

Please give the Date of Birth (dob) for your dog, if known, or the most accurate estimate of the dog's age if dob not known.*

What sex is your hound?

What color is your dog? If tricolor, tell us what color is dominant.*

Is your dog spayed or neutered?

Why do you need to give your dog away?*

Please tell us where you got your dog. If a breeder, a rescue organization, a friend, etc. Please give name and full address/contact info. *

Is your dog AKC Registered? We need a copy of the AKC registration.

Is your dog already housebroken?

Where does the dog sleep at night?*

How does your dog behave with other dogs, cats, or children? Please give as much information as possible!*

Does your dog have any 'bad' habits? Please be honest. We can work on these in our foster homes, or warn potential adopters of them.*

Does your dog have any medical problems? Give as much information as possible - medication, treatment, prognosis etc.*

Are your dogs vaccinations up to date? We will need your vet records, or a copy from your vet. If not, please explain why not.*

Has your dog been tested for heartworm within the last two years?

If the heartworm test was negative, is your hound on heartworm preventative?

How long have you owned the hound?*

Veterinarian's Name and Phone Number. We will call your vet if you have had an animal seen there within the last two years. If you have not used a vet, or have had vaccines done elsewhere, for example, please explain.*

Does your basset hound have a microchip?

If yes, please tell us the microchip number and the provider (e.g. Home Again, 24PetWatch.com, Avid etc.). THIS IS EXTREMELY IMPORTANT. If No, please answer "N/A", as this question needs to be answered to move on with the form.*

Which of the following best describes what your dog does if you touch him while he is eating?

Which of the following best describes what your dog does if you gently hug him?

Which of the following best describes your dog's behavior with strangers?

Which of the following best describes your dog's behavior with other dogs?

Has your dog ever bitten a person or another animal? If yes, please explain. *

Have you tried to rehome the dog yourself? What efforts did you try?*

When will your dog be available for rehoming? If there is a time limit after which the dog needs to be removed from your home please tell us. (It may take time to find a foster home, so we can still accept the dog for rescue and leave it with you temporarily)*

Any other information you think would be useful in finding the best home for your basset hound?

Now, take a few nice photos of your hound, gather the vet records, and write a little 'bio' - personality, likes, dislikes etc. Send these urgently to Gloria at ggbassetrescue@hotmail.com. We cannot accept your dog for rehoming until we get these details! Please say here if there will be a problem in gathering and submitting this information...*

I/We do hereby transfer ownership of the Basset Hound described herein to the GOLDEN GATE BASSET RESCUE, INC. (GGBR) rescue program IF GGBR accepts this basset into its rescue program . I warrant that I own or have legal right and authority to sell or otherwise dispose of this dog. I understand that this Basset Hound becomes the SOLE property of GGBR until such time as this Basset Hound is placed in its permanent home by that organization.*
Choose one: Yes No

I/We hereby acknowledge that I/We have read and agree to the conditions on this form. We append hereto our names by way of digital signature.*