Adoption
Questionnaire
Thank you for your interest in one of our upcoming litters!  Please be as
thorough as possible when filling out this questionnaire.  Your responses and
questions will help me determine whether a basenji is right for your family, and
what type of basenji puppy would fit best with your family.  

DISCLAIMER: Completing this form in no way guarantees your place on a
waiting list, or a puppy.  
How did you first hear about Echelon Basenjis?
(please select one)
Would this basenji live with you?
About You
Your Name
E-mail Address
How often do you check your email?
(please select one)
Street Address
State
 Zip
City
Phone number
Best time to call
Information About Your Household
Number of Adults in your household
Do all of the adults in the house agree to
the addition of a basenji to the family?
Number and age of any children in the household.  Please include any
children who are regular or frequent visitors to your home.
Are you currently expecting a child or planning a family?
Please describe a typical "day in the life" at your home including the number
of hours away from the home during the day.
Please list all other dogs that currently live in your home.  Please include
breed, sex, if they are spayed, neutered or intact, age and how long you've
owned each one.
Please list all other animals (cats, birds, bunnies, etc.) that currently live in
your home and any details that might be helpful.  
If you currently own any pets, we will contact your veterinarian for a
reference.
Veterinarian's Name
Veterinarian's City and State
Veterinarian's Phone or Email
Which best describes your house?
Do you own or rent your home?
If you rent please include landlord’s contact information.  If you own, are
there any restrictions from a homeowner’s association, etc.?
Please describe your yard and fence (yard size, fence height, type, etc.)
Is there anything else about your family that you'd like for me to know?
Information About Your General Basenji Experience
Why do you want a basenji?  What qualities appeal to you about a basenji?
Have you ever met a basenji "in the fur" or spoken with a basenji owner?
Have you ever owned a basenji before?  If so, from whom did you obtain
your basenji?  
Where will the basenji stay when you are not at home?  Where will the
basenji sleep at night?
Are you familiar with crate training?  What are your views on crate training
your basenji?
How will you exercise your basenji?
What do you know about the health problems found in the basenji breed?
Information About the Basenji You Want

(Please note that there might or might not be a puppy of your requested gender
and/or color available.  Additionally, my first consideration in placing puppies is
that their personality matches with your family.  However, I will certainly take
your preferences into consideration and make every effort to ensure that they are
fulfilled.  If you will NOT consider any deviation from your preferences, please
make sure you specify this on the questionnaire. )
Do you want:
What color do you want? (to
select multiple items, hold the ctrl
key)
Generally speaking, what kind of temperament are you looking for in a dog?
Which of the following do you
plan on doing with your basenji?  
(to select multiple items hold the
ctrl key)
If you want a show dog (conformation), have you ever
shown in the AKC before?
Do you plan on breeding your basenji?
Have you ever bred a litter before?  If yes, please describe details.
Are you currently on a waiting list with any other breeders?  Who?
Please list the names and contact information for at least two references.  
Do you have any other questions or comments?
"Reset" button will clear all entries.  "Submit" button will send your
completed questionnaire to us.
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