SOUTHEAST BLOODHOUND RESCUE, INC.

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)

 

Please print all information carefully and in legible form.

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_____________________________________________________________________________

 

 

 

Have you ever owned a Bloodhound before  * yes   * no

 

Why do you think you want a Bloodhound?___________________________________________________________________

 

_____________________________________________________________________________________________________

 

Please list the pet(s) you currently own, their species and ages:

                _________________________________________________________________

                _________________________________________________________________

                _________________________________________________________________

 

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_________________________________________________________________

_____________________________________________________________________________________________________

 

 

YOUR HOUSING SITUATION

 

Do you Own __________ Rent _____________  A House ___________ Apartment___________Condo________________

 

If Renting:  Landlord’s Name/Rental Agency__________________________________________________________________ 

  Telephone_________________________________

 

How Long have you lived at this address _______________________________

 

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_________

 

A SECURELY FENCED YARD IS REQUIRED TO ADOPT A BLOODHOUND

 

GENERAL INFORMATION REQUIRED

 

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?______________________________________________________

 

Please answer the following questions in as much detail as possible.

                Would you accept and older dog  * yes  * no _________________________________________________________

                                _______________________________________________________________________________________

                A dog that has been abused  * yes  * no ____________________________________________________________

                                _______________________________________________________________________________________

                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

                * yes  * no

 

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

                * yes  * no           After adoption  * yes  *  no

 

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

 

 

REFERENCES

 

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.

 

VETERINARIAN REFERENCE

 

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__________________________

 

 

 

AFFIDAVIT

 

I Certify that I/We are over the age of 21 years ________(initials)

 

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)

 

 

Applicants Signature

 

_________________________________________________________________Date__________

 

Spouse if applicable

 

_________________________________________________________________Date__________

 

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

EMAIL COMPLETED APPLICATION TO:   

           

            Southeast Bloodhound Rescue, Inc

            Leanne Dayvolt
          
            sebr@bellsouth.net

 

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