All Ears Basset Sanctuary

13170 Central Ave SE  #B233

Albuquerque NM  87123






Home Phone_____________________Cell Phone_____________________

How did you hear about us?_______________________________________

Number of adults in household_________Number of children____________

Ages of children________________________________________________

Is anyone home during the day?____________At night?________________

Is anyone in the home allergic to dogs?______________________________

Which family member will be primarily responsible for the dog?__________

For feeding?__________Training?___________General Care?___________

Do you realize you may have to housebreak this dog?___________________

How many hours away will he/she normally be left alone?_______________

Do you own or rent your home?_______Type of dwelling________________

Landlord name/phone_____________________________________________

Are pets allowed in rental?______________ Weight limit?________________

How does your family feel about getting a basset?_______________________


Do you presently have any pets?______________________________________


Breed                 Altered                  How long owned?     Date of last vaccines




If not spayed/neutered why not?_____________________________________

What pets have you previously owned?_______________________________

What happened to them?___________________________________________


Have you ever given up a pet before?________

If so, why?______________________________________________________


Have you ever owned a basset before___________A rescue animal__________

Have you ever had to euthanize a dog__________________________________

If so, why________________________________________________________

Please notify your veterinarian that we will be contacting them and give them permission to verify your pets’ medical records.


Why do you want to own a basset?_____________________________________


Do you have a fenced yard for the dog?__________________________________

Where will the dog be kept during the day?_______________________________

Where will the dog be kept at night?____________________________________

Do you agree to return the dog to us if you are unable to keep him/her?_________

Are you willing to have a home visit done prior to adoption?_________________

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