Loop Creek Puppy Application Form

How did you hear about Loop Creek Dachshund’s?

Full Name*

First NameLast Name

Age

E-mail*

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number - Home*

Area CodePhone Number

Phone Number - Cellular

Area CodePhone Number

Do you live in a:

Do you:

OwnRentLive with ParentsOther

If Renting: Please indicate landlord contact information

Household Setting

RuralSuburbanUrban

Describe your Homes Activity Level

Busy/NoisyModerate Comings/GoingsQuiet with Occasional Guests

Please List all People Living in the Household (Include Name, Relationship, Gender and Age)*

Does Anyone in your Household have Allergies to canines?

YesNo

Are all members of your Family agreeable in purchasing a Dog?

YesNo

Have you ever surrendered an animal to a rescue or humane society?

YesNo

If yes, what are the details on why you surrendered the animal?

Do you have a preference on gender of a puppy?

MaleFemaleNo Preference

Do you have a preference on coat? I breed all 3 coat types: smooth coat, longhair, and wirehair.

Are you looking for a specific color/pattern? Please, list all colors and all patterns that you are interested in applying for?

Please List where you’re currently receiving Veterinary Care. If you have not secured a Veterinarian; Where Do you plan to seek Veterinary Care?*

Please describe the family dynamics and/or lifestyle of you and your family. (EXAMPLE) “We are a fun loving family of 4 that is very active. We love kayaking, hiking natural trails, but we travel seldom.”

Are you prepared for the vet appointments and puppy vaccinations that must be kept on a timed schedule? Will you finish all puppy vaccinations?

YesNo

Do you have a fenced in yard?

YesNoOther

How many hours in a day would the puppy be left alone?

We cannot guarantee a puppy will be potty pad trained or housebroken at 8 weeks old. Are you equipped to train with love and patience? Positive reward training will get you far with the dachshund. They notoriously difficult to house train. Are you sure you’re equipped with patience to train this stubborn breed of dog?

YesNo

Do you plan to crate train?

YesNo

What are you plans to exercise your puppy and/or dog? Please list any parks near by or trails, how many walks a day, approximate length, and activities such as agility.

Do you agree to Loop Creek Dachshund’s Spay/Neuter Agreement and will commit to having the puppy altered by 12 months old?*

YesNo

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any Loop Creek Dachshund's dog by me.

I certify that the above information is correct, and I understand that the information will be verified.

I understand that applying doesn't guarantee that I will be granted the privilege of purchasing a puppy from Loop Creek Dachshund's.
Loop Creek Dachshund's reserves the right of 1st pick on all litters. They reserve the right to decline your application if red flags are noticed even if a deposit has been placed. In that event your deposit will be refunded back to you. Otherwise ALL DEPOSITS ARE NON-REFUNDABLE!!

Date

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Your name*

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