Adoption Application | Dachshund Rescue of Los Angeles

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Alternate Phone
Email*
Are you interested in (a) specific dog(s) listed on the website? Which one(s)?*
What type of home do you have?*
- House
- Condo
- Apartment
- Mobile Home
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 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?*
- Yes
- No
Does anyone in the home smoke?*
- Yes
- No
If yes, do you/they smoke indoors or outdoors?*
- Indoors
- Outdoors
- Both
- No smokers in the home
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 to adopt a Dachshund:*
Are you willing to teach everyone in your home, and all visitors, the proper care and treatment?*
- Yes
- No
Where will the dog(s) 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 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).****
- No
- Yes, but it is enclosed with a secure fence
- Yes, but will put in a secure fence before adopting
- Yes, 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 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)*

example: Dachshund, Female, Spayed, 4, 6 weeks
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? (if applying for a different breed, describe that breed)*
- 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 adopt a dog that is older (6 yrs. and up)?*
- Yes
- No
Would you adopt a dog that has been abused?*
- Yes
- No
Would you adopt a dog that is not reliable with children?*
- Yes
- No
Would you adopt a dog that has a physical handicap?*
- Yes
- No
Would you adopt a dog that requires regular medication?*
- Yes
- No
Would you adopt a dog that requires house training?*
- Yes
- No
What 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?*
- 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
Veterinarian's Name*
Veterinarian's Phone*
Are your pets all updated on their shots and vaccinations?*
- Yes
- No
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
Reference #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?*
- 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 LA 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".)*
- Male
- Female

Please indicate your preference on coat color.*

Black & Tan	Red	Dapple

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 Hair Smooth Hair Wired 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 Size Tweenie Size Standard 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.*
- 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.)
Please "Sign" your name below:*
Your name typed into this box constitutes your "signature" on this application: