Adoption Application

Full Name *

First Name Last Name

Your age: *

E-mail *

Phone Number *

Area Code Phone Number

Alternative Phone Number *

Area Code Phone Number

Physical Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

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.
5.

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 Code Phone 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 Name Last Name

Phone Number *

Area Code Phone Number

Reference : Full Name *

First Name Last Name

Phone Number *

Area Code Phone 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. *