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) Website BCOA Referral SMBC Referral Talked to Heather at a show Veterinarian referral Referred by a friend Would this basenji live with you? Yes No About You Your Name E-mail Address Several times a day Once a day A couple times per week Once a week Less often than once per week 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 Yes No 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? House in suburbs Apartment Condo Urban/City Farm/Rural Do you own or rent your home? Own Rent 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. ) Male Female No Preference Do you want: Red/white Tricolor Brindle/white Black/white No Preference 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) Showing in conformation Lure coursing/Racing Junior showmanship Obedience/Rally Agility Therapy work Family pet Other (please explain below) Yes No If you want a show dog (conformation), have you ever shown in the AKC before? Yes No Unsure 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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