Adoption Application

Full Name*

First NameLast Name

Your age:*

E-mail*

Phone Number*

Area CodePhone Number

Alternative Phone Number*

Area CodePhone Number

Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Name of the dog you would like to adopt:*

What type of home do you have?*

Do you own or rent your home?*

If renting, does your landlord allow pets?*

If yes, how many?*

Are there stairs in the home?*

Does your home have a "doggie door?"*

How many people are living in the home?*

INCLUDING YOURSELF, please list ALL family members and ages of those living in the home :*

	Name of the Individual	Relationship to You	Age
1.
2.
3.
4.
5.

Do you frequently have small children visiting the home?*

Are ALL family members in agreement about getting a dog?*

If no, who opposes getting a dog?*

Briefly explain the main reason you want to get a Dachshund at this time:*

Are you willing to teach everyone in your home, including all visitors, the proper care and treatment of a Dachshund?*

Where will the dog sleep?*

other:*

Do you have a fenced in yard?*

other:*

Do you have a pool?*

Do you have a pool service, gardening service, or a cleaning service?*

other:*

If you use one or more of the above, what steps do you take to keep them from letting your pets out?*

(Type N/A if you don't use any of these services.)

Have you ever owned a Dachshund?*

Do you own one now?*

Please list all pets currently in the home?*

	Name of Pet	Species	Type/Breed	Sex	Spayed/Altered	Current Age	Owned Since
1.
2.
3.
4.
5.

What brand of dog food do you feed your dogs?*

How often do you feed your dog?*

Name the pets you have had in the recent past and why they are no longer with you:*

	Pet's Name	Species	Type/Breed	Why the pet is no longer with you	How did the pet die? If applicable
1.
2.
3.
4.

Are you familiar with the unique personality of a Dachshund?*

What do you know about the characteristics of the Dachshund breed?*

Are you aware that purebred Dachshunds may not be the best choice for a family with very young children?*

Would you consider a dog that:*

	Yes	No
Is older (6 yrs +)
Has been abused
Is not reliable with children
Has a physical handicap
Requires regular medicine
Requires continued house training

What is the oldest age you will consider?*

How do you plan to house break the dog, if necessary?*

Would you consider adopting a pair of Dachshunds in the case of dogs that should not be separated and need to be placed together?*

Will the dog(s) be kept inside or outside when you are home?*

Where will the dog be kept when you are away from home or at work?*

How many hours each day will the dog be left alone?*

Rescue Dachshunds vary greatly in temperament, personality, and activity level. What characteristics would you find undesirable in a rescue Dachshund?*

Do you have a veterinarian?*

If yes, name of your veterinarian:*

Phone Number*

Area CodePhone Number

Are all your pets current on their shots/vaccinations?*

Will you take your pet to the vet for regular check ups, vaccinations, and any other medical needs?*

Are you willing to allow a home check prior to adopting a Dachshund?*

Reference: Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Reference : Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

If the situation does not work out with your family and the dog, do you agree to return the dog to Dachshund Rescue & Placement, Inc. without question?*

If, at any time, you or your family are no longer able to take of the dog, do you agree to return it to Dachshund Rescue & Placement, Inc. to ensure the dog does not end up in a pound or without a home?*

We are seeking your preferences in the following four categories

(Please select your preferences)

Preferred sex:*

	Male	Female	Either
Gender

Preferred coloring:*

	Red	Black & tan	Dapple
Coloring

Preferred coat:*

	Smooth	Long hair	Wire hair
Coat

Preferred size:*

	Mini	Tweenie	Standard
Size

Have you made plans for your pet should your Dachshund out live you to ensure it does not end up in a kill shelter?*

Who will take your Dachshund if it outlives you?*

Are you willing to pay an adoption fee of $100 to $350 for each dog you adopt from Dachshund Rescue & Placement, Inc.? (This fee helps defray medical expenses incurred while the Dachshund was in foster care and/or for the next dog that needs medical attention. There is NO profit made on money received for adoption fees.)*

Your name typed in this box constitutes your "signature" on this application.*