Adoption Application Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCĂ´te d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Alternate PhoneEmail* Are you interested in (a) specific dog(s) listed on the website? Which one(s)?* What type of home do you have?*HouseCondoApartmentMobile HomeDo you own or rent your home?*OwnRentIf renting, does your landlord allow pets?*YesNoN/AIf yes, how many?*Are there stairs in the home?*YesNoDoes your home have a "doggie door"?*YesNoHow many people are living in the home?*Please list your name and age. Also list the names and ages of any others living in the home. Your application will not be considered without this information.* Do you frequently have small children visiting your home?*YesNoDoes anyone in the home smoke?*YesNoIf yes, do you/they smoke indoors or outdoors?*IndoorsOutdoorsBothNo smokers in the homeAre all family members in agreement about getting a dog?*YesNoIf no, who opposes getting the dog?Briefly explain the main reason why you want to adopt a Dachshund:* Are you willing to teach everyone in your home, and all visitors, the proper care and treatment?*YesNoWhere will the dog(s) sleep at night?*In their own bedIn a closed-off roomIn bed with usWherever they wantOtherDo you have a fenced in yard?*NoBlock WallChain LinkWoodOtherDo you have a pool at your home?***NOTE: We do not adopt to homes with pools open to the yard. In order to adopt with us the pool must be enclosed by a secure fence. A fenced backyard is not sufficient. The pool must not be accessible by the dog(s).****NoYes, but it is enclosed with a secure fenceYes, but will put in a secure fence before adoptingYes, pool is open to the yard (note: your application will not be considered.)Do you use a pool service, gardening service or a cleaning service?*None of the abovePool serviceGardening serviceCleaning servicePool and Gardening servicesPool and Cleaning servicesGardening and Cleaning servicesAll threeIf 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?*YesNoDo you have one now?*YesNoPlease 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)* example: Dachshund, Female, Spayed, 4, 6 weeksAre all your pets spayed/neutered?*YesNoWhat 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? (if applying for a different breed, describe that breed)*YesNoWhat 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?*YesNoWould you adopt a dog that is older (6 yrs. and up)?*YesNoWould you adopt a dog that has been abused?*YesNoWould you adopt a dog that is not reliable with children?*YesNoWould you adopt a dog that has a physical handicap?*YesNoWould you adopt a dog that requires regular medication?*YesNoWould you adopt a dog that requires house training?*YesNoWhat method will you use to housebreak, or refresh the dog’s housebreaking skills?* Could you consider adopting a pair of Dachshunds in the case of dogs that should not be separated and need to be placed together?*YesNoWill the dogs be kept inside the home or outside when you are home?*InsideOutsideWhere 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?*YesNoVeterinarian's Name*Veterinarian's Phone*Are your pets all updated on their shots and vaccinations?*YesNoWill you take your pet for regular vet visits for shots and any other medical needs?*YesNoAre you willing to allow a home check prior to adopting a Dachshund?*YesNoReference #1: Name*Reference #1: Email* Reference #1: Phone Number*Reference #2: Name*Reference #2: Email* Reference #2: 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 LA without question?*YesNoIf 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 LA to ensure the dog does not end up in a pound or without a home?*YesNoPut 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".)*MaleFemalePlease indicate your preference on coat color.*Black & TanRedDapple 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".Please indicate your preference on coat type.*Long HairSmooth HairWired Hair 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".Please indicate your preference on size.*Miniature SizeTweenie SizeStandard Size 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".Have you made plans for your pet if your Dachshund should outlive you to assure it will not end up in a kill shelter? Please describe.* If the dog were to have some unexpected major medical issue or accident, what would you do? How much is the maximum you would be able to spend on a vet bill? Are you planning to buy pet insurance?* By signing below, I acknowledge that I'm willing to pay an adoption fee for each dog adopted from Dachshund Rescue. Fees vary. All fees and deposits are NON-REFUNDABLE.*YesNo(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.)Please "Sign" your name below:*Your name typed into this box constitutes your "signature" on this application: Δ