Questions for those interested in a Basenji

Your Household:

Your Name:

E-mail:

Best phone Number:
 

City:

State:  

Other people in the household (give ages and names of children):

Is anyone in your household allergic to dogs?
Yes No

Do you own or live with any other pets? Yes No
If you answered yes, please list the type of animal and if they are spayed or neutered:
Type of animal 1:     

Spayed/Neutered: Choose One Yes No

Type of animal 2:     

Spayed/Neutered: Choose One Yes No

Type of animal 3:     

Spayed/Neutered: Choose One Yes No

Type of animal 4:     

Spayed/Neutered: Choose One Yes No

Type of animal 5:     

Spayed/Neutered: Choose One Yes No

Basenji Particulars

What age of Basenji do you prefer?
Choose One Puppy (10 weeks to 6 months) Young Adult (6 months to 2 years) Adult (2 years or older)

What sex of Basenji do you prefer?
Male Female No Preference

What color of Basenji do you prefer?
Choose One Black and White Black, Tan, and White (Tricolor) Brindle and White Red and White Any color is acceptable

What other colors would you accept?
Choose One Black and White Black, Tan, and White (Tricolor) Brindle and White Red and White Any color is acceptable No other colors are acceptable

Plans for your Basenji's lifestyle:

How many hours a day will your Basenji normally be unattended?
 hours per day

Where will your Basenji stay when you are not at home?

When you are on vacation or away from home, will you take your Basenji with you?
Yes No

If not, where will your Basenji stay?


Do you own a crate?
Yes No
If not, do you plan on purchasing one for your Basenji?
Yes No

Are you willing to spay/neuter your Basenji?
Yes No

Your Home

What type of dwelling do you live in?

Choose One Apartment Condo House Other

If other, please explain:


Do you own or rent?

Own Rent

If you rent, do you have your landlord's permission to own this dog?

Yes No

Please provide contact information for your landlord here:

Do you have a fenced in yard?
Yes No

If so, please note what type of fence:

What is the height of the fence at its lowest point:

A few other things

Have you ever owned a dog?

Yes No

If so, what breed?

How long did you own it?

What happened to the animal?

Have you done any research on Basenjis?
Yes No
If so, please list what research you have done and what you have read:

Please list two references, one could be your veterinarian:

Reference 1
Name:   
Phone Number:

Reference 2
Name:   

Phone Number:

If there is any other information that you would like to share with us, please enter it here:

Powered by PHP form