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| First Name | |
| Last Name | |
| Address Line 1 | |
| Address Line 2 | |
| City | |
| State | |
| Zip Code | |
| Daytime Phone | () - |
| Evening Phone | () - |
| E-mail Address | |
| Dog you are interested in: | |
| Best time to call: | |
| Are you employed? | |
| If so, Where? | |
| How long have you been with this company? | |
| Name/age/relationship of those residing with you: | |
| Do you have a lot of visitors? If so, how many per week? | |
| Do you have grandchildren? If so, How often do they visit you and what are their ages? | |
| Does everyone in your family agree to adopting a dachshund? | |
| Has everyone in your family been exposed to dachshunds? | |
| How will you teach proper care of a dachshund to children and visitors to your home | |
| How will you monitor children around the dachshund? | |
| Are you willing to adopt a dachshund proven not reliable with children? | |
| Do you have a swimming pool? | |
| If so, is it fenced? | |
| Will you have the dachshund heartworm checked annually as required by your by your vet? | |
| What kind of heartworm preventative do you plan to use for your dog? | |
| What kind of flea and tick control do you plan to use on your dog? | |
| Will you take your dachshund to the vet when ill? | |
| Vet’s name and address and phone number: | |
| Will your family welcome this dachshund into your family as a family member? | |
| What if anything would cause you to give up your dog? | |
| If you became ill and could no longer care for the dachshund what steps would you take to give him/her a good home? | |
| Will you give this dog a long and healthy life? | |
| Has your family considered financial responsibility of owning a dachshund? | |
| Is your family able to afford $2,000 plus in vet bills if dog becomes seriously ill or has back problems? | |
| Are you willing to adopt a special needs dachshund at this time? | |
| Who will care for and where dog is to be kept when you are not in the home? | |
| How many hours per day will the dachshund be alone? | |
| Have you ever owned a dachshund before? | |
| Why do you want to adopt a rescued dachshund at this time? | |
| What other pets reside in your home at this time? If so, please give names/ages and species of pets you own now: | |
| Are your pets you own spayed or neutered? | |
| If not spayed or neutered … WHY Not = If you have any unaltered dog or cat please explain in detail why this animal has not been altered: | |
| If you have previously owned dogs, please explain what happened to those no longer living with you. | |
| What do you know about the characteristics of the dachshund breed? | |
| Are you familiar w/ their personality? | |
| Are you familiar that they are prone to/weight gain and back problems? | |
| How do you plan to execute an exercise program for your dachshund? | |
| Would you adopt an older dachshund and are you aware that they can live 15-17 yrs and some longer? | |
| Are you familiar with the fact that dachshunds are not a good choice for a child? | |
| What age preference and sex do you have in mind to adopt? | |
| Are you willing to adopt an abused dachshund? | |
| Are willing to adopt one that is not reliable w/children? | |
| Are you willing to adopt one that is handicapped? | |
| Are you willing to adopt one that requires extra meds? | |
| Are you willing to adopt 2 if they need to stay together? | |
| How do you plan to house train your dog? | |
| Do you own your own home? | |
| How long have you lived there? | |
| If you had to move what happens to your pet? | |
| Do you have a landlord, if so, please provide name and contact information | |
| Do you have a yard and if so, is it fenced? | |
| Do you have a doggie door or plan on using one? | |
| Are there stairs in your home? | |
| Where will the dog sleep at night? | |
| What do you intend to feed your dachshund? | |
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