Adoption Application

Today's Date:

Name

Address

City

State Zip Code

Home Phone

Work Phone Extension:

E-mail Address

Name, age and relationship of those residing with you.

Your age?

Do you often have other people visiting your home?
Yes No

Grandchildren?
Yes No

Other children?
Yes No

Is everyone in the residence and family agreeable to adopting a dachshund?
Yes No

Have your children (if applicable) been exposed to dachshunds?
Yes No Not applicable

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

Are you willing to teach young children the proper care and treatment of a dachshund?
Yes No

Are you willing to always monitor young children with the dachshund?
Yes No

Even a dachshund that has proven reliable with young children? Yes No

Are you willing to:

Read books about dachshunds, and discuss the dachshund breed with your veterinarian, animal behaviorists, and other professionals in order to better understand the dachshund breed and their special characteristics?
Yes No

Take the dog to a veterinarian at least once a year for a physical exam, shots, and heartworm check?
Yes No

Take the dog to a veterinarian when ill?
Yes No

Welcome the dog into your family as a permanent member?
Yes No

Return the dog ONLY to Dena Delgado and Southern California Dachshund Rescue if you decide that he/she cannot be a member of you family?
Yes No

Maintain heartworm preventative medications throughout the dog's life?
Yes No

Do everything within your power, and with the help of your veterinarian, and/or other professionals to ensure that the dog has a long, healthy life?
Yes No

Have you given careful consideration to all of the following:

Financial obligations of responsible pet ownership?
Yes No

Special needs and time and patience involved with rescue dachshunds?
Yes No

Who will care for the dog, and where will the dog be kept?

Have you ever owned a dog?
Yes No

Have you ever owned a DACHSHUND?
Yes No

Why do you want to adopt a rescued dachshund at this time?

Do you currently own any other pets?
Yes No

If yes, then please provide name, species, breed and age of each:

Have ALL of the animals listed above (if any) been spayed or neutered?
Yes No

If you have previously owned dogs, what happened to those no longer living with you?

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

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

Are you aware that purebred dachshunds can have a predisposition to back problems, weight gain, and house training problems?
Yes No

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

Are you willing to adopt a dachshund that is:

Older?
Yes No

If you checked yes above, what age are you willing to consider?:

Over 10 years 7 to 10 years 5 to 7 years

Are you willing to adopt a dachshund that is:

Abused?
Yes No

Not reliable with children?
Yes No

Physically handicapped?
Yes No

Requires ongoing medication other than heartworm preventative?
Yes No

Requires continued house training?
Yes No

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

Type of residence:
House Condominium Apartment

Own or Rent?
Own Rent

If renting, is landlord agreeable to you having a rescued dachshund?
Yes No Not applicable

Do you have a yard?
Yes No

Fenced?
Yes No

If not fenced, do you have an exercise program for the dog?
Yes No

Do you have a swimming pool or spa?
Yes No

Safety fenced?
Yes No

If not safety fenced, do you have a pool alarm system?
Yes No

Are there stairs in your residence?
Yes No

Where will the dog be kept during the day?

How many hours a day will the dog be left at home alone?

Where will the dog sleep?

Who will take care of the dog while you work?

Would you be willing to take the dog for obedience training if needed?
Yes No

Are you familiar with the necessary shots (annual) as well as heartworm testing and preventative?
Yes No

Are you familiar with flea/tick treatment and prevention? Yes No

What do you intend to feed the dog?

If needed, how will you housebreak the dog?

Please list preferences:

Color:

Red

Black and Tan

Other

No Preference

Coat:

Smooth

Long

Wire

No Preference

Size:

Standard (18 lbs and over at 12 months of age)

Miniature (11 lbs and under at 12 months of age)

"Tweenie" (that unrecognized size between 11 and 18 lbs)

No Preference

Gender:
Male Female No Preference

Preferred age range:

Anything you would like to add that would help in determining the correct animal for your living situation?

Name, address and telephone of:

Landlord (if applicable):

Veterinarian:

References:

1. 

2. 

3. 

Note: Failure to provide telephone numbers for for landlord (if applicable), veterinarian and references will result in your application being discarded without consideration.

How did you hear about us?  

Have you read and understand our adoption and rescue policies? 
 Yes  No

If you are applying to adopt a specific animal, please enter the name of the animal you are interested in here.

The information provided in this application (in its entirety) is true to the best of my knowledge as of the date on this application. I agree that submission of this form will constitute a legally signed document.
(enter your name here to "sign")

Successful submission of this form will return you to SCDR.org front page. If you are having trouble submitting, please download and fill out the word document application at the top right of the page and send to dena@scdr.org. We will get back to you no later than 2-3 days.