ADOPTION APPLICATION

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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

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

Main Phone: Work Phone

Occupation: Age:

(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

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: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: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 nside 5

Are your pets current on vaccinations/shots? YesNo

Are your pets current on heartworm preventative Yes No

f "yes", what kind/brand/form of heartworm preventative?

How often are they tested for heartworms?

How would your characterize your pets (dominant, submissive, playful, etc.)?

Will your pets accept a new dog?YesNoNot Sure

f you have previously owned pets, what happened to those no longer living with you?

Have you ever bred dogs or cats? Yes No

Are you currently breeding your dogs? Yes No

SECTION 6 : Your Veterinarian

We require information that you should have regarding your preferred local veterinarian. If you do not submit this information now, you must have it before the time of your evaluation.

Vet´s Name

Address (Line 1):

City:StateZip Code:

Contact Phone:Fax Required

SECTION 7 : Your References

Please provide 3 references (2 are permissible if a veterinarian reference was listed above). Please list the person´s name, contact information (e-mail, telephone number, or address), how long they´ve known you, and relationship to you (we prefer : employer, co-worker, neighbor, etc.).DO NOT LIST FAMILY MEMBERS--it is important to let these people expect a call to expedite your app.

Name Contact Information Time Known Relationship

Jane Doe Email & Phone 10 Years Family Friend

SECTION 8 : Certification

By signature below, I certify that I am at least 21 years of age and will assume full responsibility for the care and well being of any dog that I adopt through KDR.

I further agree to be contractually bound upon adoption to:

Take my adopted dog to a veterinarian at least once a year for a physical exam, shots, and heartworm check
Take my adopted dog to a veterinarian in a timely manner when ill
Maintain heartworm preventive medications and flea/tick treatments throughout the dog's life, and
Return my adopted dog to KDR and only to KDR should circumstances change and I can no longer care for my adopted dog in a humane manner.
Agree to not give dog away but return dog to KDR if I can no longer care of it
I understand and accept by signing below I am authorizing KDR and/or its representatives to complete a reference and background check. I also understand if my application and home evaluation is approved , I will be contacted by a KDR representative to complete the ADOPTION CONTRACT.

If filing electronically, your typed name followed by your email address (eg: John Doe, john_doe@aol.com) entered below will constitute your "electronic submission signature".

Signature: Date:

Click the submit button to enter your application--you should then see a confirmation page*From the confirmation page, send an email to verify receipt of your application.......

Send mail to KENTUCKY DACHSHUND RESCUE--109 CRAIGMOOR ESTATES, GEORGETOWN, KY 40324---FAX 502-863-5447 (CALL FIRST TO SET FAX)
Copyright © 2005 KENTUCKY DACHSHUND RESCUE
Last modified: July 13, 2005