Wait List Application

Name *

First

Last

Phone Number *

Address

City

State *

Email *

What color(s)/pattern are you interested in? *

Tri (Black, Red, and White)
Brindle
Red/White
Black/White

What age range are you looking for? *

What gender(s) are you looking for? *

Male
Female

What are you interested in for this basenji and why? *

(agility / conformation / obedience / coursing, etc.)

What is your experience with basenjis? *

What pets are currently in the home? *

(please list ages as well as kinds and genders)

What prior pets are no longer in the home?

(please include where they went as well)

What type of home do you have? *

(house, apartment, condo, etc.)

What kind of yard do you have? *

(please include information about water features and fencing)

What's your daily schedule look like? *

(please include information about how long the dog would be left at home alone and if it's consistent schedule vs ad hoc)

How many people live at the house? *

(please include ages and experience with animals)

How did you hear about/come across Chaverim Basenjis?

Other

(please include any additional information you'd like us to consider)

If what you're looking for is not available at Chaverim Basenjis, are we able to share your information with other breeders who may have what you're looking for? *

Yes
No