Adoption Application

Southeast Bloodhound Rescue, Inc. is a private charitable nonprofit rescue organization 501 (c)3. SEBR is the regional rescue organization affiliated with and approved by the American Bloodhound Club, Inc.

A processing fee of $25.00 MUST accompany the completed application. All fees must be paid via bank check, money order or Pay Pal (Pay pal requires an additional $2.00 for handling fees)

Unreadable or incomplete forms will be returned for correction and WILL delay processing.

Thank you for your interest in adopting a rescued Bloodhound. We would appreciate your answers to the following questions so we can help you select the right Bloodhound for you and your family. All information is treated as confidential. SUBMISSION and ACCEPTANCE of this application does not guarantee that you will receive a Bloodhound. Sole discretion of the approval of an application remains with the Board of Directors of the organization.

NAME________________________________________________________________________________________________

ADDRESS_______________________________________________________CITY_____________STATE____ZIP________

Telephones Home________________________________ Best Time to Call ______________________________

Work_________________________________ Best Number to Call____________________________

Cell__________________________________ Email_______________________________________

Employer___________________________________________________ How Long_________________________________

Address_____________________________________________________________________________________________

Spouse’s Name_______________________________________ Cell Phone___________________________________

Spouse’s Employer_____________________________________ How Long_________________________________

Address_____________________________________________ Telephone ________________________________

How did you hear about SEBR_____________________________________________________________________________

Why do you think you want a Bloodhound?___________________________________________________________________

_____________________________________________________________________________________________________

Are your current pets spayed/neutered *yes * no – If no why not________________________________________________

List any pets that are no longer in your home over the past 3 years________________________________________________

_____________________________________________________________________________________________________

What happened to the pets you no longer own_________________________________________________________________

_____________________________________________________________________________________________________

Do you Own __________ Rent _____________ A House ___________ Apartment___________Condo________________

If Renting: Landlord’s Name/Rental Agency__________________________________________________________________

Do you have a fenced yard? *yes * no: if yes: Height_______________ Length__________________ Width____________

Type of Fencing * chain link * privacy * Welded Farm Fence * Other – please describe_________________________

Do you have a fenced dog pen * yes * no - Size Height________ Width___________ Lenth_______ Covered_________

How many adults live in the household ___________ Children_____________ Name’s & Ages_________________________

___________________________________________________________________________________________________

____________________________________________________________________________________________________

Have the children ever been exposed to large dogs * yes * no – If yes What was the experience like_____________

____________________________________________________________________________________________________

Is there anyone in the household that is frail * yes * no – if yes explain who and what their condition is___________

____________________________________________________________________________________________________

Does any one in the household have animal related allergies * yes * no , If yes explain_______________________________

____________________________________________________________________________________________________

Do you have contact with grandchildren, other relatives that have children, or neighborhood children * yes * no

What are the working hours of the adults in the household ______________________________________________________

___________________________________________________________________________________________________

How many hours will the dog be without adult companionship _____________, adult supervision ___________________

Where will the dog be housed when you are not at home ________________________________________________________

Do you have a wire crate * yes * no _______length _______width _______height; if no are you willing to buy a crate? ___

Airline crates are not acceptable due to lack of good air circulation for extended period of time.

Where will the dog be kept during the day?___________________________________________________________________

Where will the dog sleep at night?__________________________________________________________________________

Who will be the primary responsible care taker for the dog?______________________________________________________

Would you accept and older dog * yes * no _________________________________________________________

_______________________________________________________________________________________

A dog that has been abused * yes * no ____________________________________________________________

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A dog that has a physical handicap * yes * no________________________________________________________

_______________________________________________________________________________________

A dog the requires regular medical treatment for a disorder or disease * yes * no ___________________________

_______________________________________________________________________________________

A dog that is not reliable with children * yes * no______________________________________________________

_______________________________________________________________________________________

Understanding that some rescue dogs have had little or no training are you willing to take the dog to obedience classes

Are you willing to give the rescue dog at least four (4) weeks to adjust to your home and family * yes * no

Are you willing to allow a representative of Southeast Bloodhound Rescue, Inc. to visit your home prior to adoption

Do you prefer a * Male * Female * No preference Age Range _________ to ___________

Please include any information/comments that you feel would be helpful to SEBR in placing a Bloodhound with you.

Have you applied to any other Bloodhound or All Breed Rescue for a dog? If so to What Group___________________________________________________________

________________________________________________________when__________________________________________

What was the disposition of the application______________________________________________________________________________________________

PLEASE LIST ANY BLOODHOUNDS CURRENTLY SHOWN AS AVAILABLE FOR ADOPTION THAT YOU MAYBE INTERESTED IN (Please note that all dogs may not be available at the time your application is approved – dogs can change on an almost daily basis)

_____________________________________________ _________________________________________

SEBR recommends that you/your family visit the foster home of the dog you are interested in adopting to meet the dog first. This does involve travel. Are you willing to do this? * yes * no.

SEBR will sometimes assist in transporting adopted dogs to their new homes. Under no circumstances will SEBR pay for transportation via ICC carrier, airlines, etc. This would be the sole responsibility of the adopting family if the transport is approved by the Board of Directors and the transporter is by licensed by the appropriate authorities or authorized by SEBR

All References must include complete address and telephone numbers with area codes. Please advise your references that you have submitted their names to our organization and give them your permission to speak with us. The biggest source of denied applications are incorrect telephone numbers, incomplete address and reference that do not return our calls.

Clinic Name ________________________________________________________________________________________

Veterinarian’s Name _________________________________________________________________________________

Address_______________________________ City___________________ State__________ Zip______________________

Telephone______________________________ Date of Last visit (approx)______________________________________

List one (1) reference who is A MEMBER of your family, but does not reside with you.

Name__________________________________________________ Relationship ______________________________

Address_______________________________ City_________________ State___________ Zip__________________

Day Phone _______________________ Evening ________________________ Cell__________________________

List Three Personal References who are NOT MEMBERS of your family and do not reside in your household.

Name__________________________________________________ How do you know this person._____________________

Address_______________________________ City_________________ State___________ Zip__________________

Day Phone _______________________ Evening ________________________ Cell__________________________

Name__________________________________________________ How do you know this person______________________

Address_______________________________ City_________________ State___________ Zip__________________

Day Phone _______________________ Evening ________________________ Cell__________________________

Name__________________________________________________ How do you know this person______________________

Address_______________________________ City_________________ State___________ Zip__________________

Day Phone _______________________ Evening ________________________ Cell__________________________

I/We Certify that the fact(s) contained in this application are true and complete to the best of my knowledge and understand that falsified statements or misleading statement will be grounds to decline my application prior to the adoption taking place; it will also be grounds for Southeast Bloodhound Rescue to rescind the adoption and require that the dog be returned to the point of adoption at the expense of the applicant.______________(initials)

I/We authorize investigation of all statements contained herein and authorize any questions posed to the references listed in this application to give SEBR any and all pertinent information they may have, personal or otherwise, and release the individuals and/or company from any liability or damages that may result from the utilization of such information. _________(initials)

I/We Certify that we are financially able to care for a rescue dog if I/we are approved for adoption. ___________(initials)

∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞

            Leanne Dayvolt
            61 Cypress Circle
            Carrollton, GA 30116
            (770) 836-8428
            sebr@bellsouth.net

** Original must be mail following the fax transmission for the permanent records.