Surrender Form Name * First Name Last Name Email * Phone (###) ### #### Address (We are only able rescue dachshunds in Florida) Address 1 Address 2 City State/Province Zip/Postal Code Country What is the name of the dachshund? * What sex is the dachshund? * Male Female Is the dachshund spayed or neutered? * Yes No Dachshund's age? * Dachshund's size (mini, tweenie, standard) * Mini is up to 11 lbs. and under at 12 months Tweenie is 12 lbs. to 15 lbs. Over 12 Months Standard is 16 lbs. to 32 lbs. Over 12 months Dachshund's weight? * Dachshund's color? * Dachshund's coat? * Smooth Or Short Hair Wirehair Longhair Is the dachshund a purebred or a mix? * Purebred Mix Unknown If a mix, what breed? Is the dachshund up to date on vaccinations? * Yes No Unknown Is the dachshund on heartworm preventative? * Yes No Unknown Is the dachshund on flea preventative? * Yes No Unknown Can you provide us with vet records? * Yes No Are there any medical concerns with the dachshund? * Has the dachshund ever bitten anyone? * Yes No Unknown If Yes or Unknown, Please explain. Does the dachshund like other dogs? * Yes No Unknown Does the dachshund like cats? * Yes No Unknown Does the dachshund like children? * Yes No Unknown Is the dachshund potty trained? * Yes No Unknown Reason you must re-home the dachshund? * Anything else you think we need to know about the dachshund? * Please send pictures for the dog you wish to surrender to fldrintakes@gmail.com as soon as possible. Thank you!
