Florida Dachshund Rescue – FLDR | Adoption Application

Main Email Address*

Alternate Email Address

What is the name of the dog you are applying for?

Name*

FirstLast

Address*

Street AddressAddress Line 2CityStateZip Code

Home Phone

Please use the (###)###-#### format.

Alternate Phone

What are the working hours of the adults in the house?

Who will be primarily responsible for the care of the dachshund?

Is everyone in residence agreeable to adopting a dachshund?

Yes
No

How many people residing in your home?

List their names and ages please.

Do you often have visiting grandchildren or neighborhood/other children?

Yes
No

Are you willing to teach the proper care and treatment of a dachshund to your children or any other children the dachshund would come in contact with?

Yes
No

Does anyone in residence have either (or both) Animal allergies?

Yes
No

Have you given careful consideration to the financial responsibility of pet ownership?

Yes
No

Are you aware of the time and patience and special needs involved with rescue dachshunds?

Yes
No

Please Explain

For whom are you adopting?

Why do you want to adopt a rescue dachshund?

Please list pets you now have in your home. Be sure to include the following information on each of your current pets (Breed, Male/Female, Spayed or Neutered, Age). Please be aware that FLDR has a 100% spay & neuter policy, requiring that all pets in adoptive homes be spayed or neutered, unless there is a medical reason that they should not be

Additional Information (if needed)

Are your pet (s) up-to-date on shots

Yes
No

Tested for heartworms

Yes
No

On heartworm preventative

Yes
No

Would your pet (s) accept a new dog?

Yes
No

Have you had pets in the past?

Yes
No

Please tell us about them

Do you

What type of Dwelling is your home?

If renting, we require the landlord's written consent before placing a dachshund in your home. Please include this consent when you return this application. Application cannot be processed without written consent.

Landlord's Name

FirstLast

Landlord's Address

Street AddressAddress Line 2CityStateZip Code

Landlord's Phone

Do you have a securely fenced yard?

Yes
No

What type of fence?

Fence Height

Are you willing to install a fence, pen or run

Yes
No

Leash walk at all times?

Yes
No

Do you have a doggie door?

Yes
No

Will the dachshund be supervised when outside?

Yes
No

Where will it sleep at night?

Where will it be kept when left alone?

Where and how will the dachshund be exercised?

How many hours per day will the dachshund be left alone?

Would you accept a dachshund:

That is older?

Yes
No

Has been abused?

Yes
No

Is not reliable with children?

Yes
No

Has a physical handicap?

Yes
No

Is not housebroken?

Yes
No

Would you adopt a pair of dachshunds, if they could not be separated?

Yes
No

Are there any stairs in your residence?

Yes
No

Who will care for the dachshund while you are at work?

Who will care for the dachshund when you to on vacation?

Who will care for the dachshund if you are away for the weekend?

Would the dachshund be allowed to sleep in bed with either you or other family members?

Yes
No

Would you be willing to take the dachshund for obedience training?

Yes
No

Are you familiar with the necessary annual shots?

Yes
No

Are you familiar with heartworm testing and prevention?

Yes
No

Are you familiar with flea/tick treatment and prevention?

Yes
No

What do you intend to feed the dachshund?

If needed, how will you housebreak the dachshund?

Type of dachshund preferred

Purebred
Dachshund Mix

Age preferred

Sex preferred

Coat preferred

Color preferred

Up to what age would you be willing to consider?

If you currently have pets please provide us with the information for the Veteranarian that you primarily use, as we will be calling to verify that your pets are up to date on their shots and on heartworm preventative

Veterinarian's Name

FirstLast

Address

Street AddressAddress Line 2CityStateZip Code

Phone

How long have you been a client?

References

(Do not list any relatives or people living with you)

Name*

FirstLast

Reference 1

Address*

Street AddressAddress Line 2CityStateZip Code

Home Phone*

Email

Name

FirstLast

Address*

Street AddressAddress Line 2CityStateZip Code

Phone*

Email

Have you ever been turned down by any rescue organization for adoption of a rescued animal?

Yes
No

Why?

Are you working with another rescue organization?

Yes
No

Please list the name of the organization and the contact person you are working with

Contact person name:

I understand that upon submitting this document for review, that it is legally binding and any false information given will be just cause for immediate denial of adopting a rescued dachshund from this organization.

Please type in your name above