KENTUCKY DACHSHUND RESCUE, INC. - Adoption Application

SECTION 1 : Your Information

E-mail Address  

First Name:    

Last Name:            

Address (Line 1):                            

Address (Line 2):  

 City:    County    State AL AK AR AZ CA CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NE NH NC ND NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VT VA WA WI WV WY                        

Zip Code:   Area of state (ex: N, S, W, E, SW,NW                        

Main Phone:                                                                                      Work Phone       

Occupation:           Age:  21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100     

(You must be at least 21 years old to adopt from KDR-                                            

SECTION 2 : Your Household

Please list the name, age, and relationship of all persons residing in your household.             

       Name                                       Age                       Relationship  

     1    1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100   

     2      1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100   

    3     1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100     

    4         1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100     

   5          1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100  

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

 Do you or anyone in your family have a handicap or illness that would prevent caring for dog?

Why do you want to adopt a dachshund?

Is everyone in the  family agreeable to your adopting a dachshund?YesNo

Does anyone in the residence have animal allergies?                       YesNo

Does anyone in the residence have asthma?                                     Yes No

If you have children and/or frequent visitors to your home, please answer the following questions:

Are you aware purebred dachshunds are not the best choice for families with very young children?                                                                                                   Yes No

Have your children had exposure to owning and caring for family pets YesNo              such as dogs or cats?

Have your children ever  owned or cared for dachshunds in  particular? YesNo           

If "no",

 How will you teach your children to love and care for your dachshund   in a humane manner?

Should  your dachshund becomes agitated by or frightened of loud children or visitors to your home, do you have the ability to separate your pet from children or visitors to avoid problems? (i.e. gated or separate rooms, fenced outdoor areas, etc.)YesNo

f "yes", how?

SECTION 3 : Your Home

Type of residence: apartment condo house houseboat mobile townhouse other Do you own or rent?OwnRent

If renting, be advised you must provide written documentation to  Kentucky Dachshund Rescue from your landlord confirming you are authorized to house and maintain pets on the property (i.e. letter from landlord, pet addendum, or proof of pet deposits).

Landlord´s Name

Address (Line 1):

Address (Line 2)

City:State: AL AK AR AZ CA CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NE NH NC ND NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VT VA WA WI WV WY Zip Code:

Contact Phone:

Do you have a yard?                                                                                 Yes No

What is the approximate size of your yard?
Is your yard completely fenced?                  YesNo

What type and how tall is your fence?

f you do not have a fenced yard, are you willing to fence it, ?                  Yes No

When?

Do you feel it acceptable to let your dog roam freely outside the        Yes   No           house without a fence?    

Are there stairs in your residence?                                                          Yes No

Are you aware that dachshunds are prone to back strain and injuries    Yes No              and should not be allowed to climb stairs?

Are you familiar with the unique personality of the dachshund breed?  YesNo

How?

Are you aware that purebred dachshunds are susceptible to weight Yes  No             gain and/or house training problems?

Have you ever housetrained a dog before?                                            YesNo

If "yes", how did you housetrain?

Where will the dog be kept during the day?

Where will the dog sleep?

Where and how will the dog be exercised?

How many hours a day will the dog be at home alone?

          SECTION 4 : Your Adoption Preferences

Names of Dog(s) interested in (if known)

Please indicate your desired preferences to assist us in our search for a compatible pet companion by checking all applicable boxes.

Breed                                Gender                     Age                       

 Dachshund             Male                         Under 1 year *

Dachshund Mix        Female                 1-3years   

                                                                           4-7 years

                                                                          8 years and up

Size                                                                        Coat                      

Mini (12 lbs. and under)                      Smooth Hair

 Tweenie (13 - 24 lbs.)                         Long Hair

     Standard (25 lbs. & over)                 Wire Hair      

Are you willing to adopt a dachshund that...

 is not reliable with children?                                                                                 YesNo

is physically handicapped?                                                                                    YesNo

has been abused?                                                                                                   YesNo

 requires ongoing medication other than heartworm preventative?                   YesNo

requires continued house training?                                                                        YesNo

Attend dog obedience  training classes ?                                                               YesNo

Attitude
Dachshunds vary greatly in temperament, personality, and activity level.
What characteristics, if any, would you find undesirable in a dachshund?

Bonded Pairs                                                                                                                                  We occasionally receive pairs of dogs who may or may not be siblings but who nonetheless have bonded and need to remain together.

Would you consider adopting such a bonded pair, if available?YesNo

SECTION 5 : Your Pet History

Do you currently own any pets?                                                          YesNo

If "yes", please list species / breed, sex, whether the pet is neutered or spayed, if the pet is kept primarily inside or outside and how many years you have owned this pet. (See example below)

Pet Name Species / Breed  Gender   Fixed?   Age (years) Kept In/Out?  Yrs Owned?

Oscar      Dog / Dachshund      Male       Yes           10                inside          5

1 Male Female Yes No 0+ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20+ Inside Outside 0+ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20+

2 Male Female Yes No 0+ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20+ Inside Outside 0+ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20+

3 Male Female Yes No 0+ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20+ Inside Outside 0+ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20+

4 Male Female Yes No 0+ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20+ Inside Outside 0+ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20+