Household & Family Dynamics


Type of residence?
House   Condo   Apartment  Mobile Home  Other

Do you own or rent?
Own   Rent   Other

If you rent, is landlord agreeable to pets on the premises?
Yes   No   Not applicable

Do you have a yard?
Yes   No    Yard size:

Is your yard completely fenced in?
Yes   No    Type/height of fencing:

If no, what type of exercise program will you set for your dachshund?

Are there stairs in your residence?
Yes   No

Please list the names, ages and relationships of those residing with you.

Do you often have other people visiting your home?
Yes   No

Grandchildren?
Yes   No

Other children?
Yes   No

Have your children (if applicable) been exposed to dachshunds?
Yes   No  Not applicable

How will you monitor young children around your dachshund?

Are you aware that dachshunds are not the best choice for families with very young children?
Yes   No

Is everyone in the residence and family agreeable to adopting a dachshund?
Yes   No

Pet Experience


Have you ever had a dog?
Yes   No

Have you ever had a dachshund?
Yes   No

What happened to any previous dogs no longer living with you?

Do you currently have any other pets?
Yes   No

If yes, please provide name, species, breed and age of each:

Are all your pets spayed or neutered?
Yes   No

If not spayed/neutered, please explain why.

Are all your pets up to date on annual vaccinations?
Yes   No

If not up to date on vaccinations, please explain why.

Are you familiar with the necessary shots (annual) as well as heartworm testing and prevention?
Yes   No

Are you familiar with flea/tick treatment and prevention?
Yes   No

Are you familiar with proper dental care for your dog?
Yes   No

Dachshund Breed


Are you familiar with the unique personality of a dachshund?
Yes   No

Are you aware that dachshunds are susceptible to weight gain and house-training problems?
Yes   No

Would you be willing to take the dachshund for obedience training if needed?
Yes   No

Please list some characteristics that the dachshund breed exhibits:

Are you aware that dachshunds are susceptible to back injuries?
Yes   No

Are you aware that treatment for back injuries may require surgery at a cost of $3,500 or more?
Yes   No

Would you consider all options for a dachshund with back-related injuries (e.g., steroid treatment, surgery, acupuncture, cart) before euthanasia?
Yes   No

How would you be willing to accommodate a dachshund with a back injury (e.g., ramps, carrying up stairs)?

A dachshund's average life expectancy is 14 to 16 years. Are you fully committed to caring for the dog its entire life?
Yes   No

Please give an estimate of the annual cost for routine care of a dachshund (food, vetting, preventative, etc.).

Care of the Dachshund

Why do you want to adopt a rescued dachshund?

Who will be primarily responsible for the care of the dachshund?

Sometimes rescue dachshunds have special needs and require patience and understanding. Please list some special needs that you think a rescue may have.

How many hours a day will the dog be left at home alone?

If you work out of the home, who will take care of the dog while you are away?

If you work out of the home, are you able to come home during a lunch hour or hire a dog walker if necessary?
Yes   No

Who will care for your dog when you travel?

Where will the dog sleep at night?

Where will the dog be kept during the day?

What type of dog food do you intend to feed the dog? (e.g. brand name, wet, dry, etc.)

Dachshunds can sometimes be difficult to housebreak. If needed, how will you housebreak your dog?

Preferences

Are you willing to adopt a dachshund that is older?
Yes   No

If yes, what age are you willing to consider?:
8 to 10 years   11 to 12 year   13 to 15 years   16+ years

Are you willing to adopt a dachshund that...

Was abused?
Yes   No

Is not reliable with children?
Yes   No

Is physically handicapped?
Yes   No

Requires ongoing medication other than heartworm preventative?
Yes   No

Has previous back-related injuries?
Yes   No

Requires continued house training?
Yes   No

Would you consider adopting a pair of dachshunds in the case of dogs that should not be separated and need to be placed together?
Yes   No

Dachshunds come in a variety of colors, coat types, and sizes. Please select your preferences below:

Color
Red   Black & Tan   Chocolate & Tan
Other   No Preference

Coat
Smooth   Long   Wire   No Preference

Size
Miniature (10 lbs or less)   Tweenie (11 - 18 lbs)
Standard (19 - 35 lbs)   No Preference

Gender
Male   Female   No Preference

Preferred age range in years
Under 1*   1 - 3   4 - 6   7 - 9   10+

*Note: It's rare that MWDR rescues dachshunds under the age of one year.

If you are applying to adopt a specific dachshund, please enter the name below.

Anything you would like to add that would help in determining
the right dachshund for your living situation?

References

Name, address and phone number of landlord (if applicable):

Name, address, phone number, and fax number of veterinarian:

Name, address, email address, and phone number of
three personal references:
1.

2.

3.

If you are currently working with a MWDR Representative, please provide his/her name and e-mail address:

Name:   
E-Mail:  

By signing below, I give permission for a MidWest Dachshund Rescue, Inc., representative to contact my landlord, veterniarian and/or personal references. I acknowledge that I have completely read this adoption application, comprehend it fully, know that applying does not ensure approval and that untruthful answers or failure to comply with requirements of this application or the adoption contract can result in the forfeiture of any MidWest Dachshund Rescue dog adopted by me.

Enter your name: