Request for an ID number
Coast to Coast Dachshund Rescue - c2cdr.org
This form is for members of Coast to Coast Dachshund Rescue only.
Date
-
Month
-
Day
Year
Date
Your name
*
First Name
Last Name
Your email
*
example@example.com
Your phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Dog's name
*
If you changed the name but there was an original name, what was it?
Is this dog a purebred or a mix?
Purebred
Possible mix
Definite mix
If the dog is a mix, what do you think the dog is mixed with? Remember, mixes must have board approval first before you can bring them in and you must send a picture of the dog to the board email.
Sex of dog
*
Male
Female
Is the dog spayed or neutered?
Spayed Female
Unspayed Female
Altered Male
Unaltered Male
Age of dog or approximate age of dog.
Coat Type
*
Smooth
Longhaired
Wirehaired
Coat Color
*
Weight of dog (approximate)
Upload an image of the dog if you have one.
Who is fostering this dog?
*
I am
I have a foster home
Other
If you're using a foster home, please put their full name.
First Name
Last Name
Address of foster home
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this dog from a shelter? Owner-surrender? Other? Please fill in where you obtained this dog.
Name of veterinary clinic you'll be taking the dog to.
*
Phone number of veterinary clinic you'll be taking the dog to.
Address of Veterinary Clinic if you have it on hand.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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