Dachshund Adoption Rescue and Education, Inc. - Adoption Application
SECTION 1 : Your Information RED color indicates a required field.
E-mail Address:
First Name:
Last Name:
Address (Line 1):
Address (Line 2):
City:      State: 
Zip Code:
Main Phone:
Second Phone:
Occupation:
Age:  (You must be at least 21 years old to adopt from DARE)
SECTION 2 : Your Household

Please list the name, age, and relationship of all persons residing in your household.
#) Name Age Relationship
1)
2)
3)
4)
5)
 
Who will be primarily responsible for the care of your dachshund?
Is everyone in the residence and family agreeable to your adopting a dachshund? Yes No
Does anyone in the residence have animal allergies? Yes No
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 such as dogs or cats? Yes No
Have your children had exposure to owning and caring for dachshunds in particular? Yes No
If "no", will you teach your children to love and care for your dachshund in a humane manner? Yes No
In the event 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.) Yes No
If "yes", how?
SECTION 3 : Your Home
Type of residence:  Do you own or rent? Own Rent

If renting, be advised you must provide written documentation to DARE 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? Yes No
What type and how tall is your fence?
If you do not have a fenced yard, are you willing to fence it, or install a dog run, or leash walk at all times? Yes No
Do you feel it acceptable to let your dog roam freely outside the house? Yes No
Are there stairs in your residence? Yes No
Are you aware that dachshunds are prone to back strain and injuries and should not be allowed to climb stairs? Yes No
Are you familiar with the unique personality of the dachshund breed? Yes No
Are you aware that purebred dachshunds are susceptible to weight gain and/or house training problems? Yes No
Have you ever housetrained a dog before? Yes No
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  1-3 years
     4-7 years
Size Coat  8 years and up
 Mini (12 lbs. and under)  Smooth Hair * rarely available.
 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? Yes No
... is physically handicapped? Yes No
... has been abused? Yes No
... requires ongoing medication other than heartworm preventative? Yes No
... requires continued house training? Yes No
... requires obedience training? Yes No
 

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? Yes No
SECTION 5 : Your Pet History
Do you currently own any pets? Yes No

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? Years Owned?
0) Oscar Dog / Dachshund Male Yes 10 Inside 5
1)
2)
3)
4)
5)
Are your pets current on vaccinations/shots? Yes No
Are your pets current on heartworm preventative? Yes No
If "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? Yes No Not Sure

If 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/cats to have puppies/ kittens? 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):
Address (Line 2):
City:      State: 
Zip Code:
Contact Phone:
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 (sister, brother, friend, employer, co-worker, neighbor, etc.).
#) Name Contact Information Time Known Relationship
0) Jane Doe jd@aol.com, (999)-555-1212,
12 Main Ln., Acity, FL		 10 Years Family Friend
1)
2)
3)
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 DARE.

I further agree to be contractually bound upon adoption to:

  1. take my adopted dog to a veterinarian at least once a year for a physical exam, shots, and heartworm check
  2. take my adopted dog to a veterinarian in a timely manner when ill
  3. maintain heartworm preventive medications and flea/tick treatments throughout the dog's life, and
  4. return my adopted dog to DARE and only to DARE should circumstances change and I can no longer care for my adopted dog in a humane manner.

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: 06 - 20 - 2013