adoption application

We at Kaleonahe Basenjis are dedicated to finding the perfect home for each of our dogs. We do not place a dog unless we feel it is the perfect home. We ask that you please take a few minutes to fill out our adoption application so we may get a chance to know you a little better!

Tell us about you:

Name:

Street Address:

City:   State:   Zip Code:

Phone Number: (H)   (C)    (W)

Email address: (1)    (2)

Do you have children? Yes No
If you answered yes, please list name and age of your children here:


Please list the name and age of other people in the household:


Is anyone in your household allergic to dogs? Yes No

What type of dwelling do you live in?
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:

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:
Type of animal 2:   Spayed/Neutered:
Type of animal 3:   Spayed/Neutered:
Type of animal 4:   Spayed/Neutered:
Type of animal 5:   Spayed/Neutered:

Have you ever owned a dog? Yes No
If so, what breed?
How long did you own it?
What happened to the animal?

Tell us about your desired Basenji:

What age of Basenji do you prefer?

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

What color of Basenji do you prefer?
What other colors would you accept?

Tell us how your Basenji will live:

Will your Basenji live indoors or outdoors? Indoors Outdoors

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

Do you have plans to breed your Basenji? Yes No

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

A few last questions:

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 must be your veterinarian:

Reference 1
Name:   Phone Number:

Veterinarian
Name:   Phone Number:

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