Full Name:
Street Address:
City:
State:	ZIP code:
Home phone (with area code):
Work phone (optional):
Cell phone (optional):
E-mail*:

* You must enter an e-mail address to submit this application.

If you are working with an AHDRS member, please provide the member's name and e-mail address:

Member's Name:
Member's E-Mail:

If you are applying to adopt a specific animal, please enter the name of the animal here.

How did you hear about AHDRS?

< Your Preferences>

Preferred Color: No Preference Red Black and Tan Other

Preferred Coat: No Preference Smooth Long Wire

Preferred Size: No Preference Minature (up to 11 lb) "Tweenie" (11 - 18 lbs) Standard (18 lbs and up)

Gender: No Preference Male Female

Preferred age range:

If you indicated preferences, please explain. Are you flexible? Do you have a second choice?

Are you willing to adopt a dachshund mix? Yes No

Are you willing to adopt a Dachshund that:

Has been abused and therefore may be anxious or may take a while to warm up to you? Yes No

Is not reliable with children? Yes No

Has a physical deformity or handicap? Yes No

Requires ongoing medication other than heartworm preventive? Yes No

Is not completely housebroken? Yes No

Are you willing to adopt a pair of dachshunds that cannot be separated? Yes No Maybe

<Your Pets>

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? How do they react?

Have ALL of the animals listed above (if any) been spayed or neutered? Not Applicable Yes No

If no, what are the circumstances?

If you have previously owned dogs, what happened to those no longer living with you?
Please provide a complete answer (e.g. if a dog died, what was the cause of death and age of the dog?):

<You and Your Family>

Please list the name, age and relationship of all people residing with you:

How often, on average, do other people visit your home?

Explain briefly how you will introduce visitors to your dachshund.

How have you taught your children (or how would you teach visiting children) to interact with a dog?

Who will be the primary caregiver for for the dog?
Who will care for the dog when the primary caregiver is away--at work or on vacation?

How many hours will the dog be left at home alone during the day? Where will the dog be kept during those hours?

Type of residence: House Condominium Apartment

Own or Rent: Own Rent

Is your yard completely fenced? Not Applicable Yes No

If so, how high is the fence?

If renting, is landlord agreeable to you having a rescued dachshund? Not Applicable Yes No

If renting, please provide the name, address and phone number of your landlord.

Name:
Street Address:
City:
State:	ZIP code:
Telephone:

<Living with a Dachshund>

What would you say are the best dachshund characteristics? The worst?

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?

Please describe what you know or assume about the special needs of rescue dachshunds:

What is your opinion of obedience training? Have you ever done it with one of your dogs?

Where will the dog sleep?

What do you intend to feed your 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 AHDRS to retrieve information from your veterinarian. PLEASE CALL YOUR VET AND TELL THEM TO RELEASE THE INFORMATION WE NEED TO ALMOST HOME WHEN THE REPRESENTATIVE CALLS! We cannot process applications without information from your vet.

Veterinarian's name:
Street Address:
City:
State:	ZIP code:
Telephone:

Personal Reference

Please provide the name, location, and telephone number of someone who knows you well and is not a personal friend, for example an employer, clergy or associate in an organization. You may also provide additional references. Please be sure to include a telephone number for each reference.

Personal reference name:
Street Address:
City:
State:	ZIP code:
Telephone:

Personal reference name:
Street Address:
City:
State:	ZIP code:
Telephone:

Comments?

The information provided in this application (in its entirety) is true to the best of my knowledge as of the date on this application.
I agree that submission of this form will constitute a legally signed document.

Enter your name here to "sign":
Date: