*Home Telephone:
Employer:
Work Telephone:
Spouse's Employer:
Work Telephone:
Reminder: Press
the "Tab" key to move to the next field:
What are the working hours
of the adults in the house?:
Who will be primarily
responsible for the care of the dachshund?:
Is everyone in residence
agreeable to adopting a dachshund?:
yes
no
How many people residing
in your home?:
Please list names and
ages of all people living in your home:
Do you often have visiting
grandchildren or neighborhood/other children?
yes
no
If not, are you willing to
teach the proper care and treatment of a dachshund to your children or any other
children the dachshund would come in contact with?:
yes
no
Does anyone in residence
have either (or both) Animal allergies?:
yes
no
Have you given careful
consideration to the financial responsibility of pet ownership?:
yes no
Are you aware of the
special needs of a rescue dachshund?:
yes
no
Are you aware of the time
and patience involved with rescue dachshunds?:
yes
no
Please Explain:
For whom are you
adopting?:
Why do you want to adopt a
rescue dachshund?:
Please list pets you now
have in your home. Be sure to include the following information on each of your
current pets:
Breed Owned
Male/Female
Spayed or Neutered
Age Date
Other Comments:
Are your pet (s)
up-to-date on shots:
yes
no tested
for heartworms:
yes
no
on heartworm preventative:yes
no
Would your pet (s) accept
a new dog?: yes
no
Have you had pets in the
past?: yes
no
If so, please tell us
about them:
Reminder: Press
the "Tab" key to move to the next field:
Do you own:
a
If renting, we require the
landlord's written consent before placing a dachshund in your home. Please
include this consent when you return this application. Application cannot be
processed without written consent.
Landlord's name:
Street:
City:
State: Zip Code:
Telephone:
Do you have a securely
fenced yard?: yes
no
What type of fence?:
How high?:
If not, are you willing to
install a fence, pen or run
yesno
or leash walk at all times?:
yes
no
Do you have a doggie
door?: yes
no
Will the dachshund be
supervised when outside?:
yes
no
Where will it sleep at
night?:
Where will it be kept when
left alone?:
Where and how will the
dachshund be exercised?:
How many hours per day
will the dachshund be left alone?:
Would you accept a
dachshund:
That is older?:
yes
no
Has been abused?:
yes
no
Is not reliable with
children?:
yes
no
Has a physical handicap?:
yes
no
Is not housebroken?:
yes
no
Would you adopt a pair of
dachshunds, if they could not be separated?:
yesno
Are there any stairs in
your residence?:
yes
no
Who will care for the
dachshund while you are at work?:
Who will care for the
dachshund when you to on vacation?:
Who will care for the
dachshund if you are away for the weekend?:
Would the dachshund be
allowed to sleep in bed with either you or other family members?:
yes
no
Would you be willing to
take the dachshund for obedience training?:
yes
no
Are you familiar with the
necessary annual shots?:
yes
no
Are you familiar with
heartworm testing and prevention?:
yes
no
Are you familiar with
flea/tick treatment and prevention?:
yes
no
What do you intend to feed
the dachshund?:
If needed, how will you
housebreak the dachshund?:
Reminder: Press
the "Tab" key to move to the next field:
Type of dachshund
preferred:
Purebred
Dachshund Mix
Age preferred?:
Sex preferred?:
Coat preferred?:
Color preferred?:
Up to what age would you
be willing to consider?:
If you own other
animals, please fill out the following section:
Veterinarian's Name:
Street:
City:
State: Zip Code:
Telephone:
How long have you been a
client?:
Reminder: Press
the "Tab" key to move to the next field:
* = Required fields
REFERENCES:
Reference No. 1 (Do not
list any relatives or people living with you)
*Name:
*Street:
*City:
*State: *Zip Code:
*Home Telephone:
E-mail address:
Reference No. 2 (Do not
list any relatives or people living with you)
*Name:
*Street:
*City:
*State: *Zip Code:
*Home Telephone:
email address:
Have you ever been turned
down by any rescue organization for adoption of a rescued animal?:
yes
no
Why?:
Are you working with
another rescue organization?:
yes
no
If yes, please list the
name of the organization and the contact person you are working with.
Contact person name:
I understand that upon
submitting this document for review, that it is legally binding and any false
information given will be just cause for immediate denial of adopting a rescued
dachshund from this organization.
Please type in your name
below:
*Signature:
___________________________________________________