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
Please Select
Afghanistan
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The Gambia
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Other
Country
Name of the dog you would like to adopt:
*
What type of home do you have?
*
Please Select
House
Apartment
Mobile Home
Condominium
Do you own or rent your home?
*
Please Select
Own
Rent
If renting, does your landlord allow pets?
*
Please Select
Yes
No
N/A
If yes, how many?
*
Are there stairs in the home?
*
Please Select
Yes
No
N/A
Does your home have a "doggie door?"
*
Please Select
Yes
No
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?
*
Please Select
Yes
No
Are ALL family members in agreement about getting a dog?
*
Please Select
Yes
No
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?
*
Please Select
Yes
No
Where will the dog sleep?
*
Please Select
in the bed with us/me
in a crate
in it's/their own bed
in a closed off room
other: please explain
other:
*
Do you have a fenced in yard?
*
Please Select
no
block
chainlink
wood
other: please explain
other:
*
Do you have a pool?
*
Please Select
No
Yes, with a security fence
Yes, open to the yard
Do you have a pool service, gardening service, or a cleaning service?
*
Please Select
all three
pool service
gardening service
cleaning service
pool & gardening service
pool & cleaning service
gardening & cleaning service
none of the above
other: please explain
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?
*
Please Select
Yes
No
Do you own one now?
*
Please Select
Yes
No
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?
*
Please Select
Once a day
Twice a day
Three times a day
Free feed
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?
*
Please Select
Yes
No
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?
*
Please Select
Yes
No
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?
*
Please Select
Yes
No
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?
*
Please Select
Yes
No
If yes, name of your veterinarian:
*
Phone Number
*
-
Area Code
Phone Number
Are all your pets current on their shots/vaccinations?
*
Please Select
Yes
No
N/A
Will you take your pet to the vet for regular check ups, vaccinations, and any other medical needs?
*
Please Select
Yes
No
Are you willing to allow a home check prior to adopting a Dachshund?
*
Please Select
Yes
No
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?
*
Please Select
Yes
No
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?
*
Please Select
Yes
No
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?
*
Please Select
Yes
No
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.)
*
Please Select
Yes
No
Your name typed in this box constitutes your "signature" on this application.
*
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