We appreciate your interest in our breed! Please complete the following so that we may know you better.
Date:
Name of Adopter: Address: City/State/Zip:
Home phone: Work phone: Cell phone: Best time to contact:
Email Address:
Personal reference name: Reference phone:
Why do you want to own a dachshund?
What dogs do you currently have (breed, sex, age, neutered/spayed)?
How do your dogs get along with other dogs?
Please list all pets owned in the past 10 years and why they are no longer with you:
Have you ever had a dog euthanized? Yes No If Yes, Why?
Have you ever surrendered a dog to the animal shelter? Yes No If Yes, Why?
Have you ever given away a dog? Yes No If Yes, Why?
Do you own cats? Yes No Are they use to dogs? Yes No Not Applicable
Name and phone number of veterinarian:
Name of Flea/tick prevention or treatment used: Name of Heartworm prevention used:
Fenced yard? Yes No Fence height / type?
How long would the dog would be left alone: Where the dog stays when alone? Do you have a dog door into house or garage? Yes No Do you own/have you used a dog crate? Yes No Where do your pets stay when you go on vacation? Age/sex/relationship of children in contact with dog: Own your home? Yes No If no, contact info for landlord: Have you adopted a dog before? Yes No Please name the rescue agency:
Please specify the NAME or what age/sex/color/size of Dachshund you are looking for (if there is a preference)
Please type in the characters you see above
