ADOPTION APPLICATION

Please fill out this form to apply to adopt a rescue Dachshund

Application should be filled out by an adult in the household applying

First Name:
Last Name:
Address:	(Physical address, please, no P.O. Boxes)
City:	State: Zip:
Home Phone(with area code):	(DR&P adopts only to those in AZ, CA & NV)
Cell Phone (with area code):
Email address:

Are you interested in (a) specific dog(s) listed on the website?
Beau
Heidi
Maggie
Munchkin
Rosie
Toby
Wally
Webster
Whatever dog is meant for me
What type of home do you have?
House Mobile Home Apartment Condo

Do you own or rent your home?
Own Rent

If renting, does your landlord allow pets?      Yes No N/A

If yes, how many?

Are there stairs in the home?      Yes No

Does your home have a "doggie door"?      Yes No

How many people are living in the home?

Please list family members and their ages (remember to include yourself):
(The number of names AND ages listed MUST equal the number in the last question)
(Application will not be considered without this information!)


Do you frequently have small children visiting your home?     Yes No

Are all family members in agreement about getting a dog?      Yes No

If no, who opposes getting the dog?


Briefly explain the main reason why you want a Dachshund at this time:

Are you willing to teach everyone in your home, and all visitors, the proper care and treatment of a Dachshund?      Yes No

Where will the dogs sleep at night?
In their own bed
In a closed-off room
In bed with us
Wherever they want
Other

Do you have a fenced in yard?
No Block Wall Chain Link Wood Other

Do you have a pool?
No With security fence Open to the yard

Do you use a pool service, gardening service or a cleaning service?
None of the above
Pool service
Gardening service
Cleaning service
Pool and Gardening services
Pool and Cleaning services
Gardening and Cleaning services
All three

If you use one or more of the above, what steps do you take to prevent them from letting your pets out?
(Type "N/A" if you don't use any of the services)


Have you ever had a Dachshund before?      Yes No

Do you have one now?      Yes No

Please list pets you now have in your home. Be sure to include the following information on each of your current pets:
Type/Breed              Sex     Spayed/Neutered     Age     Owned Since (age)


Are all your pets spayed/neutered?      Yes No

What brand(s) of dog food have you fed your pets in the past?

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

Are you familiar with the unique personality of a Dachshund?      Yes No

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

Are you aware that purebred Dachshunds are not the best choice for families with very young children?   Yes No

Would you accept a dog that:

Is older (6 yrs. and up)?     Yes No

What's the oldest age you will consider?

Has been abused?      Yes No

Is not reliable with children?      Yes No

Has a physical handicap?      Yes No

Requires regular medication?      Yes No

Requires continued house training?      Yes No

How do you plan to housebreak 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?      Yes No

Will the dogs be kept inside the home or outside when you are home?
Inside Outside

Where will the dogs 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 rescued Dachshund?


Do you have a veterinarian?      Yes No
If yes, name: Phone Number:

Are your pets all updated on their shots and vaccinations?      Yes No N/A

Will you take your pet for regular vet visits for shots and any other medical needs?
Yes No

Are you willing to allow a home check prior to adopting a Dachshund?      Yes No

References:
Name: Phone Number:
Name: Phone Number:

If the situation does not work out with your family and the dog, do you agree to return the dogs to Dachshund Rescue & Placement without question?      Yes No

If at any time in the future, you or your family are no longer able to care for the dog, do you agree to return the dog to Dachshund Rescue & Placement to ensure the dog does not end up in a pound or without a home?      Yes No

Put your selection of what type of Doxie you are looking for in order of preference. (Use "1" for your first choice, "2" for your second and "3" for your third. If you would not accept a dog of that type, put "0".)

GENDER	COLORING	TYPE OF COAT	SIZE
Male Female	Black & Tan Red Dapple	Long-Hair Smooth Wire-Hair	Miniature Tweenie Standard

Have you made plans for your pet if your Dachshund should outlive you to assure it will not end up in a kill shelter?      Yes No

Who will take your dog if it outlives you?

Are you willing to pay an adoption fee of $100 - $300 for each dog you receive from Dachshund Rescue?     
Yes No
(This fee helps defray medical expenses incurred while the Doxie was in foster care, and/or for the next dog that needs medical attention. There is no profit made on any money received for adoption fees.)

Your name typed into this box constitutes your "signature" on this application:

     

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