DEVILS PEAK BASENJIS ADOPTION APPLICATION
The following questions are being asked of you so that the right dog or puppy and the right placement of each dog or puppy is made by bringing the various requirements of both the dog or puppy and his new owner(s) into perspective, BEFORE a choice is made. I hope you will agree that the animal's welfare must be our foremost consideration in a placement. Please answer the following questions as completely as you can, and click submit when finished.

Thank you,
Martina Cortez
Cindy Austin

Name:
Address

Home Phone
Cell Phone

Email address:

Occupation
Marital status:

Approx. age
Referred by

Do you want?

Show Pet Show/Compainion Either

Do you want?

Male Female Either

Do you want?

Puppy Adult Either

Color Preference?

Red & White Black, Tan & White Black & White Brindle & White Any Color

Have you ever owned a dog before?

Yes No

Have you ever owned a Basenji before?

Yes No

Others in household who will have contact with the dog:

How many people live in your household?

1 2 3 4 +5

Animals currently in the home (species, age, sex,):

Are your other animals spayed or neutered?

Yes No Some

Children and Ages:

Does anyone in your household have allergies to animals?

Yes No

If yes, how severe:

 

Do the primary care providers have any medical problems or concerns that we should be aware of that might affect the living conditions of this dog?

Do you or any members of your household smoke?

Yes No

If yes, where -
In Car In House Outside

Expecting/planning a family ?

Yes No Not Sure

What will you do with the dog if you have a new baby?

Have kids visit?

Yes No

About my Family:

If you were separated or divorced what would happen to the dog?

Whom would the dog go with?

If your job was to change and you had to move, would you take the dog with you?

Yes No

 

Vet's Name
Vet's Address

Vet's Phone

 

What qualities do you like about basenjis?

What qualities do you dislike about basenjis?

How long have you lived at this address:

1 2 3 4 5 6 7 8 9 10+

Our Neighborhood is:

Urban Rural

How will the dog be confined when he is outside?

1-2 Hours 3-4 Hours 5-6 Hours 7-8 Hours 9+ Hours Dog will live outside Never

Fenced-in yard?

Yes No

Please describe the type & height of fencing.

Why are you interested in this breed?

How did you hear about this breed?

What reference materials have you read about Basenji?

Have you spoken to a Basenji Owner/Breeder (and whom?):

Would you like to visit a Basenji?

Yes No

What do you expect the activity level of this breed to be:

Very High High Moderate Below Average

Willing to walk the dog (even in bad weather)?

Yes No

Keep on lead at all times?

Yes No

Willing to crate dog when you can’t supervise:

Yes No

Will you spay/neuter?

Yes No
Care for the dog all its life?

Yes No
Who will be the primary care giver?

Yes No

What brand of dog food have you fed in the past?

What are your thoughts on premium brand dog food?

Have you considered an older dog instead of a puppy?

Yes No
Is anyone home during the day?

Yes No
How many hours on average will the puppy/dog be left alone?

1-2 hours 3-4 hours 5-6 hours 7-8 hours 9+ hours
Will there be someone available to feed and exercise the puppy/dog during the day?

Yes No
Where will the dog stay during the day?

Outside Inside
Where will the dog stay at night?

Outside Inside
Who will care for the dog while you are on vacation?

Friends Family Boarding Kennel
How long has it been since you raised a puppy?

1-2 years 3-4 years 5+ years Never
Have you ever housetrained a dog before?

Yes No

What behavior problems do you feel are unacceptable?

How do you plan to work with behavior problems you encounter?

Will you be attending any training classes?

Yes No
Have you ever returned a pet to the breeder?

Yes No

If yes, what were the circumstances?

Do you intend to breed the dog?

Yes No

Expectations/Concerns/Comments: