First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone*
x

Cell Phone*

Alt Email

Text/Pager Email

I certify that the below information is true and understand that false information may result in an application denial and/or nullification of any adoption. I understand that All Texas Dachshund Rescue reserves the right to refuse an adoption to anyone for any reason with or without cause. *
Choose one: I Agree

How did you hear about us?*

Have you applied with any other rescue group?*
Choose one: Yes No

Which dog are you interested in? (NOTE: We cannot promise that by the time your application is processed that the dog you're applying for will still be available).
Choose an animal: Amos (must be adopted with Kyler) Bennie Bonnie B Cane Canelo (must be adopted with Julian) Chacho (must be adopted with Chicho) Chicho (must be adopted with Chacho) Chloe Diva Dragon Franny Julian (must be adopted with Canelo) Kyler (must be adopted with Amos) Lily Lizzie Matty (must be adopted with Mazey) Mazey (must be adopted with Matty) MoMo Mya Olaf Paco Rocket Rusty Sassy Sherry Sugar Buns Swanson Tebeau Tiger

Name of dog(s) you're interested in, if not listed above (NOTE: We cannot promise that by the time your application is processed that the dog you're applying for will still be available).

Have you owned any pets in the past?*
Choose one: Yes No

Where are these pets now? Please elaborate.*

Have you ever given up a pet? If yes, please explain*

Do you currently have any pets?*
Choose one: Yes No

Please list name, species, breed, gender and age of each pet currently owned. If no current pets, enter N/A.*

Are your pets (dogs and cats) spayed or neutered?*
Choose one: No Yes N/A

Are your pets (dogs) on heartworm preventative?*
Choose one: No Yes N/A

When and where was your heartworm preventative purchased? If no pets, enter N/A.*

Including yourself, please list the NAMES and AGES of all family/household members.*

Whom are you adopting this dog for?*

Is everyone living at the residence agreeable to adopting a rescued dog?*
Choose one: Yes No

Do you often have other people visiting your home?*
Choose one: Yes No

Do you often have children visiting your home?*
Choose one: Yes No

Are you willing to teach young children the proper care and treatment of this dog?*
Choose one: No Yes N/A

Are you willing to always monitor young children with this dog?*
Choose one: Yes No

Have you given careful consideration to the financial obligations of responsible pet ownership?*
Choose one: Yes No

Are you willing and financially able to take the dog to a veterinarian at least once a year for a physical exam, vaccinations, fecal, and a heartworm test?*
Choose one: Yes No

Are you willing and financially able to take the dog to a veterinarian if it becomes sick or injured?*
Choose one: Yes No

Will you maintain heartworm preventative medications throughout the dog's life?*
Choose one: Yes No

Will you welcome this dog into your home as a permanent family member?*
Choose one: Yes No

Will you do everything in your power, with the help of your veterinarian, and/or other professionals to ensure that the dog has a long, happy, healthy life?*
Choose one: Yes No

Will you agree to immediately return any adopted dog to All Texas Dachshund Rescue, Inc. upon demand or if the dog does not work out for any reason?*
Choose one: Yes No

Have you given careful consideration to the special needs, time, and patience involved with a new pet in the home?*
Choose one: Yes No

Who in the household will care for the pet*

Why are you interested in adopting a pet at this time*

Why have you chosen a Dachshund or Dachshund mix as your preferred breed to adopt*

Have you read about and researched the Dachshund breed, their characteristics, personality traits and breed specific health issues?*
Choose one: Yes No

Do you understand the importance of keeping your dachshund at a trim, healthy weight to help avoid issues with Intervertebral Disc Disease (IVDD)?*
Choose one: Yes No

In what type of home do you live*
Choose one: Single Family Duplex Apartment Condominium Mobile Home

Do you own or rent your home*
Choose one: Rent Own

If you rent, is your landlord agreeable to you having this pet?*
Choose one: No Yes N/A

If you rent, please enter your landlord's name, address, email and phone number. If you do not rent, put N/A*

Do you have a yard?*
Choose one: Yes No

Is your yard fenced?*
Choose one: Yes No

If fenced, what type of fence?*
Choose one: Wooden Wrought Iron Chain Link Other

What is the height of the fence?*
Choose one: 3 FT 4 FT 6 FT 8 FT N/A

Are you willing to make any and all repairs/modifications to your fence if requested*
Choose one: No Yes N/A

Will the dog have access to a doggie door?*
Choose one: Yes No

How will you exercise the dog?*

Where will the dog be kept when you are not home?*

How many hours a day will the dog be left at home alone?*
Choose one: 0 - 4 5 - 8 8 +

Where will the dog sleep?*

Who will care for the dog while you're at work?*

Who will care for the dog if you are no longer able to*

Would you be willing to take the dog for obedience training if needed?*
Choose one: Yes No Depends on the dog

What do you intend to feed the dog?*

Veterinarian: Please list the NAME, ADDRESS, PHONE NUMBER and EMAIL of your veterinarian. Please list N/A if you have never owned a pet*

Personal Reference 1: Please provide NAME, ADDRESS, PHONE NUMBER & EMAIL of personal reference NOT related to you or living in your home.*

Personal Reference 2: Please provide NAME, ADDRESS, PHONE NUMBER & EMAIL of personal reference NOT related to you or living in your home*

Personal Reference 3: Please provide NAME, ADDRESS, PHONE NUMBER & EMAIL of personal reference NOT related to you or living in your home*

Your place of employment.*

Your occupation.*

Work address:*

Spouse/significant other place of employment:

Spouse/Significant other occupation:

Spouse/Significant other work address:

Spouse/Significant other work phone number:

Do you have any additional comments you would care to make?