DRNC Adoption Application

Date of Application:

MonthDayYear

Name of the Dog I want to adopt*

Why I want this dog:*

If this dog is a gift the recipient MUST complete this form. NO exceptions.

Is this dog intended as a gift for another person?*

YesNo

How did you hear about us?

Other: (please specify)

Full Name*

First NameLast Name

Age*

E-mail*

Home Phone*

Area CodePhone Number

Cell Phone

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Employer

Work E-mail

Work Phone

Area CodePhone Number

Phone # you prefer us to use:*

HomeWorkCell

List ALL residents in the home, including yourself:*

	Name of Individual	Email address of Individual	Age	Relationship to you
1.
2.
3.
4.
5.

Is everyone in the household willing to make a lifetime commitment to the new dog?*

yesno

If not, why?

Does anyone in the home have allergies?*

What kind of allergies?

I live in a*

that I*

My home has*

My yard is*

Type of fence

Fence height:

If you have a fence, is it secure?

Can passersby see into your yard?*

Do you have pool, pond or jacuzzi?*

If so, is it fenced for security?

Do you have stairs inside?*

yesno

Number of stairs:*

Do you have stairs outside?*

yesno

Number of stairs:*

If you rent, do you have your landlord's permission to own a dog?

Landlord's Name and Phone:

Do you currently have other pets in the home?*

If so, please list all pets in the home:

	Species	Breed	Age	Sex	Spayed or Neutered	Current on vaccinations
1.
2.
3.
4.
5.

What type of flea control do you use?

Have you owned dogs that you no longer own?

If yes, please give a brief description of what happened to the dog. Please be specific, if deceased, what did the dog die of, etc.:

Have you ever given up a dog?

If yes, explain why:

What would ever cause you to euthanize a pet?

What situation would force you to rehome a pet?*

Veterinarian*

E-mail

Phone Number*

Area CodePhone Number

I realize dogs need food, supplies, medications, grooming, etc. The following is an estimate of the annual cost per dog:*

What will you feed your dachshund?

Have you ever owned a dachshund before? If so, give a brief description of your experience:*

What do you know about dachshund personalities?*

What do you know about dachshund breed specific problems?*

Dachshunds are prone to back problems: How do you plan to prevent the dachshund from injuring it's back?*

How many hours will the dachshund be left alone?*

Hours per (select one):*

dayweekmonth

Where will the dachshund be left when alone?*

Will the dog have access to a doggie door while you are away?

If not, how will you handle the dog's elimination needs while you are away from home?

I understand that dogs left alone can dig, chew, and bark. I plan on dealing with these issues in the following way:*

At what age do you think children are old enough to play with a dachshund?

Do you have children/grandchildren that visit frequently?*

Please list all children/grandchildren that frequently visit your home:

	Name	Age	Relationship to you	Avg # of visits per month	Good with other pets
1.
2.
3.
4.
5.

Have the children/grandchildren cared for pets before?

What types of pets?

What will you teach them about handling the dachshund?

What will you do if the dachshund injures the child?

What will you do if the child injures the dachshund?

Will the dachshund be allowed on the furniture? Why or why not?*

Where will the dachshund sleep during the day? at night?*

Will you crate train your dachshund? Why or why not?

What kind of exercise will you provide for the dachshund?

How will you correct unacceptable behavior?*

How do you plan to housetrain your dachshund?*

When you travel, how will you provide for the dachshund?*

What will happen to your dog if something should happen to you and you could no longer care for it?*

If your first choice is not available, what is your preference in the following (check all that apply):

Preferred sex*

	male	female	either
sex

Preferred age*

	puppy	young	adult	senior
Age

Preferred size*

	micro mini	mini	tweenie	standard
Size

Preferred coat*

	smooth	longhair	wire
Coat

Preferred color*

	red	black and tan	chocolate and tan	dapple	dble dapple	piebald
Color

Preferred color - other:

Will you consider the following:*

	Yes	No
a bonded pair
requires housetraining
has been abused
has a physical handicap
is recovering from treatment
is not reliable with children

I want this dog because (please rate in the order of importance to you):*

	Yes	No
for myself
for protection
for my children
for hunting
for other pets
as a guard dog
other (explain)

Explain other:

I understand that the initial adjustment period for a dog and it's owner is critical. Please specify how long you plan to be with the dog before you leave it alone (days, hours):

Have you ever tried to adopt from us or any other rescue? If so, what was the outcome?

REFERENCES: (husband/wife or boyfriend/girlfriend or fiancee not acceptable:*

	Name of Individual	Relationship to you	Email Address	Phone Number
1.
2.
3.

I certify that I am at least 21 years of age.

I agree to a home visit by a DRNC representative.

I give permission to have my references checked, including the Veterinarian I listed in this form.

I agree to pay an adoption fee for each dog adopted. I understand the adoption fees range from $100 to $400 per dog adopted. I understand that non payment of the adoption fee in any form for any dog adopted constitutes a breach of contract and the dog will be returned to DRNC or a DRNC designated representative.

I agree to give the adopted dog at least two weeks to adjust to being in a new home. It is very important that everyone in the home be allowed this adjustment period.

By typing my name below to sign this form and clicking SUBMIT, I agree and certify that all the information provided in this application (in it's entirety) is true and correct as of the date of submission. I understand that my application may be denied if false information is given or if it is discovered that information has been ommitted whether on purpose or by accident.

I agree that submission of this form will constitute a legal document once submitted. I understand that submission of this form does not guarantee I will be approved to adopt a dog from Dachshund Rescue of Northern California.

I agree to the above Terms and Conditions*

yesno

Please type your name to "sign"*

Adoption Application

Personal Information

Residence and Family Information

Pet History

Veterinarian, Health & Behavioral Information

Adoption Preferences

References

Terms and Conditions