Name
Email
Co-applicant's Name
Co-applicant's Email Address
Address
City
State
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip
Best number to reach you at
Are you working with any other rescue groups?
RESIDENCE INFORMATION:
How long have you lived at the above address?
Type of residence:
House
Condo/Townhouse
Apartment
Other
If you are renting or living in a managed community, we require landlord &/or condo board consent before placing a dachshund in your home.
If you rent, does your landlord allow pets?
What is your landlords (apartment complexes) name and phone number?
How many times have you moved in the past 6 years?
Do you have a doggie door?
Is the yard fully fenced with no fence gaps?
If yes, what is the height of the fence and what type of material is it constructed from?
If you answered yes, is your pool above ground or below ground?
Above Ground
Below Ground
If you answered yes to the above question, is there a fence around the pool?
If you have an in ground pool, does it have an alarm?
Are you willing to allow a representative from GDR visit your home and inspect where the dog will be kept and take pictures to present to the adoptions team?
Please list the names and ages of everyone who resides in your home
Does anyone in the household have allergies to animals?
How often do you have other people visiting your home, including children and grandchildren?
Have the children that live in and/or visit your home been exposed to dachshunds?
Do you have children in your home under the age of 5 years?
Do you have children visit your home under the age of 5 years?
How will you expose your dog to children over the age of 5 years?
DOG INFORMATION:
If you are interested in a specific dog, please list the dog's name here. Our goal is to find the best matched dachshund for your home:
What age of pet are you looking for?
Where will your new dog stay?
Will the dog have access to the entire house?
If no, where will the pet be allowed
If no fence, how do you plan to keep the dog on the property?
Fenced Yard/Area
Chain
Runner
Tie out
Leash walk
Pen/Kennel
Run free
Other
Who will be responsible for the daily care of the dog?
What is the longest period of time the dog would be home alone on an average day?
What do you plan to do with your dog when you go on vacation?
How do you plan to prevent fleas and ticks?
What do you expect to pay for annual pet care? (vet care, flea control, medications, vaccines, ect)
If your pet develops a serious medical condition that becomes expensive, what would you do?
Are you familiar with IVDD?
If yes, please explain
Dachshunds are often difficult to housetrain. How will you handle this?
Do you plan on taking your dog to obedience training?
Please explain your reason for the answer above.
Under what circumstances do you think it is ok to leave the dog loose outside and unsupervised?
In a quiet subdivision
On a lot of acreage
In a rural area
When I know they are trained to come back
None
Other
COMMITMENT:
Can you provide a safe and loving home for this dog for 10 -15 years?
Are you prepared to take your dog to the veterinarian if it becomes ill and include a regular annual checkup in the dogs veterinarian care?
Are you familiar with the challenges of being a pet parent to a dachshund?
Understanding that dachshunds may be standoffish with newcomers to the home, how would you handle this situation?
What accommodations are you willing to make to help your newly adopted pet adjust?
How long are you willing to work with your adopted pet to help them adjust to their new home?
What do you enjoy most about being a pet parent?
What do you enjoy least about being a pet parent?
CURRENT AND PAST PET INFORMATION:
Please list the pets currently in your home below. Be sure to include name, type of animal, breed, age & sex
How many pets have owned in the past 5 years?
Where do your current pets sleep at night?
Are all of your current pets spayed and neutered?
Are all of your current pets current on vaccinations?
Are all of your current pets on heartworm prevention?
If your pets are NOT on heartworm preventative please explain why.
Have you ever had a serious behavioral problem with a pet?
If Yes, please explain
What type of food ( be specific) do you feed your pet?
Have you ever surrendered a dog?
If you answered yes to the previous question, please explain.
VETERINARIAN INFORMATION:
Please provide your vet’s name and contact information. Please advise your vet that we will be contacting them and give them permission to release your information. If you have more than one vet that cares for your pets please email this information to: adopt.gdxrescue@gmail.com
Veterinarian's Name
Veterinarian’s Address
City
State
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code
Phone
How long have you been a client?
REFERENCES:
Please List 2 personal references not related to you OR living with you.
Name of reference 1
Address
City
State
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip
Phone
Email
Name of reference 2
Address
City
State
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip
Phone
Email
Please type in your name in the box below, which is your digital signature.
SIGNATURE OF APPLICANT
SIGNATURE OF CO- APPLICANT
Todays date
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