Cascadia Basset Hound Rescue

Dog Listing Form

Owner Information

Owner’s Name Home Phone

Address Work Phone

City State Zip email

Best time to call r Morning r Afternoon r Evening r Weekend

Co-owner Name, if any: Home Phone

Address Work Phone

City State Zip email

Dog’s Identifying Information

Basset is r Purebred r Mix with ____________________

Dog’s call or everyday name ________________ Age:______________

Color Weight Sex Spayed/neutered? r Yes r No

Dog’s registered name

Are AKC papers available r Yes r No

If yes, will you provide these to new owner? r Yes r No

How long have you owned this dog?

Was dog bought from a r breeder r pet store r shelter?

Name/location:

If not bought from breeder, pet store or shelter, how did you get the dog?

Placement Attempts

Has the breeder been contacted about providing a home?

r Yes, declined r No, unable to contact r Other

If the dog was bought from a shelter, have you contacted them about return of dog?

r Yes, declined r No, unable to contact r Other

Is the dog co-owned? r No r Yes, with:

Has the co-owner been contacted about providing a home?

r Yes, declined r No, unable to contact r Other:

Health Information

Has this Basset had regular veterinary care? r Yes r No

If yes, name of veterinarian:

Address: Phone Number

Are veterinary records available? r Yes, attached r Yes, will provide r No

Are shots current?

Rabies r Yes r No When due?

Parvo r Yes r No When due?

DHLP r Yes r No When due?

Other: r Yes r No When due?

Has the dog been treated for injury in the past year? r Yes r No

If yes, please describe:

_________________________________________________________________

Has the dog been treated for illness in the past year? r Yes r No

If yes, please describe:

Does the dog have any physical problems? r Yes r No

Does the dog have allergies? r Yes r No

Is the dog on medication? r Yes r No

If yes to above, please explain:

If the dog is an unspayed female, when was her last heat cycle?

If the dog is an unspayed female, is there any chance that she is pregnant?

Behavior Summary

Is this Basset Hound:

Housebroken? r Yes r No Paper trained? r Yes r No

Crate trained? r Yes r No Leash trained? r Yes r No

Has this dog ever:

Bitten another dog? r Yes r No

Bitten a person? r Yes r No

Snapped at/threatened a child? r Yes r No

If yes to any of these, explain circumstances:

How does dog react to:

Other dogs r Don’t know r Likes r Scared r Aggressive

Cats r Don’t know r Likes r Scared r Aggressive

Strangers r Don’t know r Likes r Scared r Aggressive

Children r Don’t know r Likes r Scared r Aggressive

Alone in yard? r Don’t know r Quiet r Barks/howls r Destructive

Alone in house? r Don’t know r Quiet r Barks/howls r Destructive

Alone in car? r Don’t know r Quiet r Barks/howls r Destructive

Has this dog had any training? r Obedience r Tracking r Hunting

What commands does the dog know/obey?

r Sit r Down r Stay r Off r Other:

Does the dog know any tricks? r Yes: r No

Care of dog

What brand food does dog eat?

How much total daily?

How often is the dog fed? r 1X/day r 2x/day r Free-feed

Where has the dog spent the day? (check all that apply)

r Loose indoors r Crated r Basement/garage r Loose in fenced yard

r Loose unfenced r Tied out r Kennel or dog run

Where has the dog spent the night? (check all that apply)

r Loose indoors r Crated r Basement/garage r Loose in fenced yard

r Loose unfenced r Tied out r Kennel or dog run

What is the longest the dog usually was left alone?

Placement

Why are you placing this dog for adoption?

What are your dog’s most appealing points?

Is there anything you recommend we avoid in placing your dog?

Return, with listing agreement, to:

Sylvie McGee, 9121 Littlerock Rd SW, Olympia WA 98512

or by fax to: 516-706-1233 or by email: Sylvie@seanet.com