Name * First Name Last Name Email * Address * We Only Adopt To Florida Residents Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### What is the name of the dachshund you are applying for? What are the working hours of the adults in the home? * 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 reside in your home? * 1 2 3 4 5 6 7 8 9 10 Please list names, ages and occupations of all adults living in the house (including yourself). * You must be at least 25 years of age to adopt and have no children younger than 7, living with you. Do you often have visiting grandchildren or neighborhood/other children? * Yes No Are you a snowbird? * Yes No Have you given careful consideration to the financial responsibility of pet ownership? * Yes No Are you aware of the time, patience and special needs involved with rescue dachshunds? * Yes No Who are you adopting the dog for? * Why do you want to adopt a rescue dachshund? * Please list all pets you now have in your home. Be sure to include the following information on each of your current pets (Pet's Name, 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. We will be calling your vet to verify that your pets are spayed or neutered, up to date on their shots and on monthly heartworm preventative. Are your pet(s) up-to-date on shots (vaccinations)? Yes No Do not currently have pets Tested for heartworms? Yes No N/A On heartworm preventative? Yes No N/A Would your pet(s) accept a new dog? Yes No Unsure N/A Have you had pets in the past? Yes No Have you ever given a dog away? If yes, please explain. Do you: * Own Rent What type of Dwelling is your home? * Single Family Home Townhouse Condo Apartment Do you have a securely fenced yard? * Yes No N/A Do you have a swimming pool? * Yes No Do you have a doggie door? * Yes No Will the dachshund be supervised when outside? * Yes No Where will your new Doxie sleep at night? Where will your new Doxie be kept when left alone? Where and how will the doxie be exercised? How many hours per day will the dachshund be left alone? Dachshunds are very prone to back problems and often suffer from IVDD which may require surgery that can cost as much as $4,000 and result in months of physical rehabilitation, with no guarantee that your dog will not suffer any degree of permanent paralysis. Should your dog have back problems and require surgery, what would you do? * 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 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 are 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 How would you correct a dog if it misbehaved or did something wrong? Are you familiar with the necessary annual shots (vaccinations)? 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? A rescue dog may or may not be housetrained & patience is needed. Even a housetrained dog may have an accident when first getting to a new home. Type of dachshund preferred? Purebred Mix Either Preferred age? Puppy Adolescent Senior No Preference Sex Preferred? Male Female Either Coat preferred? Short Hair Long Hair Either If you currently have pets (or if they passed away within the last year), please provide us with the information for the veterinarian that you primarily use, as we will be calling to verify that your pets are spayed or neutered, up to date on their shots and on monthly heartworm preventative. Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### How long have you been a client? 2nd Veterinary Practice Name (if you have been with your current vet less than 2 years) Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Reference 1 * (DO NOT LIST ANY RELATIVES OR PEOPLE LIVING WITH YOU.) First Name Last Name Phone (###) ### #### Email Address Address 1 Address 2 City State/Province Zip/Postal Code Country Reference 2 First Name Last Name Phone (###) ### #### Email Address Address 1 Address 2 City State/Province Zip/Postal Code Country Have you ever been turned down by any rescue organization for adoption of a rescued animal? * Yes No Are you working with another rescue organization? Yes No How did you hear about Florida Dachshund Rescue? 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. * Thank you!
