Adoption Application and Agreement
Full Name: __________________________________________________________________
Street Address: _______________________________________________________________
City: ______________________________ State: _____________ Zip Code: _____________
Home Phone with area code: ___________________
Cell (optional): ____________________
Work Phone (optional): _______________________
Email: ___________________________
Is the pet for: Yourself _____ Children ______ Family ______
Someone Else _____ Gift ____
Is this pet to be mostly: Companion _____ Watchdog _____ Hunter _____
Farm Dog ____ Breeder _____
Will this pet be primarily: A House Pet _____ An Outside Pet ______
If an outside pet, what shelter do you have for it? ____________________________________
Do you have a fenced in yard? __________ Will it be leashed? ________
Run free? _______
Do you own or rent the place you live? ____________________________________________
If you rent does the landlord allow pets? ____________________________________________
Landlord’s Name, Address, and Phone: _____________________________________________
_____________________________________________________________________________
Is your residence a: House _____ Mobile Home ____ Farm ____
Acreage ____ Apartment ____
If this is an indoor pet where will you keep it when you are not at home? ___________________
Who will be the primary caregiver for the dog? _______________________________________
Will someone be home to housebreak it if necessary? __________________________________
Do you know how to housebreak an animal? _________________________________________
How will you discipline your pet? __________________________________________________
How long will this pet be alone? ___________________________________________________
If you have children what are their ages? ____________________________________________
If you have children what will their role be in caring for this per? _________________________
____________________________________________________________________
Do you currently own any other pets? Yes _______ No ________
If yes, please provide name, species, breed, and age of each: _____________________________
_____________________________________________________________________________
If you own dogs, how would you describe their personalities? Dominant, submissive, playful, aloof etc.:
_____________________________________________________________________________
If you own cats, have they been exposed to dogs? ____________________________________
_____________________________________________________________________________
Have all the animals listed above been spayed or neutered? _____________________________
If not, what are the circumstances? _________________________________________________
______________________________________________________________________________
What routine medical treatments/preventives do you consider necessary for a dog? ___________
______________________________________________________________________________
About how much would you expect to spend annually on medical care for a healthy dog? ______
______________________________________________________________________________
Where will the dog sleep? ________________________________________________________
What do you intend to feed you dog?________________________________________________
References
Veterinarian.
Please provide the name, location and telephone number of your veterinarian
(required for all applicants who have owned a companion animal).
NOTE: By submitting this application you give permission to
Dakota Dachshund Rescue to retrieve information from your veterinarian.
PLEASE CALL YOUR VET AND TELL THEM TO RELEASE THE INFORMATI
WE NEEDWHEN THE DAKOTA DACHSHUND RESCUE REPRESENTATIVECALLS.
We cannot process applications without the information from your vet.
Veterinarian’s Name: ____________________________________________________________
Street Address: _________________________________________________________________
City: ______________________________ State: _____________ Zip code: ________________
Telephone: ____________________________________________
Personal Reference: please submit 2 individuals who know you well such as an employer,clergy, or an associate in an organization.
1. Name: _________________________________
Phone number: _____________________
Street Address:
_______________________________________________________
City: ______________________________ State: _____________
Zip code: ________________
2. Name: _________________________________
Phone number: _______________________
Street Address:
_______________________________________________________________
City: ______________________________ State:_____________
Zip code: ________________
Signature ____________________________________ Date ________________
