Dachshund Haus Rescue Application
The application to complete to adopt or foster a dachshund.
Email address *
Are you applying to adopt, foster, or both? *
Required
Contact Information
Full Name *
Your answer
Occupation *
Your answer
Address *
Your answer
How long have you lived at this address?
Your answer
Do you have a home owner's association? *
Does your home owner's association have a # of dogs you can have?
If there is a limit on the # of dogs you can have please enter it here:
Your answer
Day time phone number? *
Your answer
Evening phone number? *
Your answer
What is the best time to call?
Your answer
Family & Housing
How many adults are there in your family? (Please include age and relationship to you) *
Your answer
How many children? Please include ages.
Your answer
Do any small children visit often? Please include ages. *
Your answer
Do you have a plan in place for your dogs if you should become unable to care for them? (please describe it) *
Your answer
What type of home do you live in single family, town home, apartment, farm, etc.? *
Please describe your household: *
If you rent, please give the rules governing pets and the landlord’s name and number:
Your answer
Does anyone in the family have a known allergy to dogs? *
Is everyone in agreement with the decision to adopt a dog? *
Does anyone in the household smoke? *
Do you have time to provide adequate love and attention? *
Your answer
Other Pets
What other pets do you have? (Please specify type, breed, and the number owned) *
Your answer
Are these pets up to date on vaccines?
Are these pets spayed/neutered? If not, why?
Your answer
Have you ever surrendered a pet? If so, why? *
Your answer
Have you ever had a pet euthanized? If so, why? *
Your answer
Have you ever lost a pet to an accident? *
How do you discipline your pets and why? *
Your answer
Veterinarian
Do you have regular veterinarian? *
What is your veterinarian's name?
Your answer
What is the name of the veterinarian's clinic?
Your answer
What is the address of the veterinarian's clinic?
Your answer
What is the phone number of the veterinarian's clinic?
Your answer
About the Dog You Wish To Adopt
If you are applying with a specific dog from our website in mind, please list the dog's name here. (You will still need to complete the form in its entirety)
Your answer
What is your idea of an ideal dog and why? *
Your answer
Desired age of the dog you wish to adopt: *
Your answer
Desired size of the dog you wish to adopt: *
Your answer
Desired breed of the dog you wish to adopt: *
Your answer
What breed of dog would you NOT adopt? *
Your answer
What is the desired sex of the dog you wish to adopt? *
Are you willing to adopt: (please select all that apply) *
Required
Where will the dog spend the day? (Please describe) *
Your answer
Where will the dog spend the night? (Please describe) *
Your answer
What is the average number of hours that the dog will spend alone, per day? *
Your answer
Who will have primary responsibility for this dog's care? *
Your answer
Who will have financial responsibility for this dog? *
Your answer
Have you ever used a correction collar? *
Do you agree to provide regular health care by a License Veterinarian? *
Do you agree to keep the dog as an indoor dog? *
When the dog goes out, how do you plan to supervise it? Fenced yard, staked out, leash? *
Your answer
Do you agree to surrender back the dog to Dachshund Haus Rescue if you can no longer keep it? *
Are you be willing to let a representative of Dachshund Haus rescue visit your home by appointment? *
How did you hear about Dachshund Haus Rescue?
Personal References
Please list two references who are familiar with both you and your pets. Include their name, address, phone number, and relationship (relative, friend, neighbor, etc). *
Your answer
All of the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian. (Your response to this question serves as your digital signature. If you select "no" on this question your application will not be considered.) *
A copy of your responses will be emailed to the address you provided.
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