Rebec Bassets
Reed and Becky Pomeroy 
  N5803 Jordson Coulee Rd. 
West Salem, WI  54669 
Phone: (608) 786-3495


Puppy Adoption Questionnaire
Thank you for inquiring about a Rebec Basset. 
This questionnaire is designed to help in placing every puppy into the best possible home. 
We would appreciate it if you would complete the form entirely and 'submit.'

Name
Occupation

Work Phone
Email

Home Phone  
Spouse
Spouse Occupation

Spouse Work Phone

Other Phone
Address
City   Zip
How did you hear about us?
What are the ages of any children living in your home or spending a lot of time with you? (If none, do you expect this to change in the future?)
What adults live in your home or spend a lot of time with you? Do you expect this to change in the future?
Does every member of your family want a dog  
If "No", please explain.
What types of hobbies does your family enjoy?
What made you decide to get a dog?
Why did you decide on a Basset?
Do you prefer male or female?
Color preference?
For what purpose are you purchasing a Basset? (Please hold down the 'Ctrl' key and click on your mouse for multiple selections.)
Do you presently have other animals?
If you had other dogs previously, what happened to them?
Have you had any unfavorable experiences with dogs in your past?
Do you have any specific concerns about Bassets?
Is anyone in the home allergic to dogs? 
Do you own or rent your home?
Do you live in a house or apartment? 
Have you owned a Basset before? 
Where will you keep this puppy?
Is your yard fenced
If you do not have a fenced yard or dog run, will this be provided in the future?

Do you understand we ask that you do not be kept tied outside or allowed to run loose in an unenclosed area and that the dog be walked on a leash outside of the fenced area? 
Does this create a problem for you? 
Are you willing to use a crate as a home for your Basset if no one is home to supervise him/her? 
Do you understand the financial responsibilities of having a pet?
Are you willing to spay/neuter your Basset (if a pet quality puppy is purchased)?
If you are not willing to spay/neuter your dog, please explain
By submitting this form, I agree that all the above information I have provided on this application is, to the best of my knowledge, true and complete.