Adoption Candiate Form

In order to be considered for placement of a rescued dachshund, we need general information about you, your family and your environment. Please take the time to fill out the form below. We will never sell this information. You will only receive email from our organization. Please e-mail our group with your questions or concerns.

Out of state families: Please keep in mind that transport may be an issue. We are a small group and are not able to travel long distances to place dogs in new homes. We will not transport dogs in cargo areas of planes. If you are unable to help with transportation, please be advised that we may not be able to place a dog with your family.

Name

Address

City/State/Zip / /

Phone

Work Phone

E-mail

If you are interested in one of the avaliable Dachshund, which one:

Sex: Male Female No Preference

Color: Red Black & Tan No Preference Other (Please specify

Size: Mini Standard No Preference

Hair: Short Long Wire No Preference

Do you have children? Yes No

If yes, what are their ages:

Have you owned Dachshund before? Yes No

Do you own any other pets? Yes No

If yes, Please list them here:

Is your yard fenced? Yes No

Would you be able to provide a vet reference? Yes No

If yes, the vet's name

The vet's phone number

Is there anything else you would like to add?

Now press "Send It!" to submit your information or "Start Over" to clear the form.

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Name
Address
City/State/Zip	/ /
Phone
Work Phone
E-mail

Sex:	Male	Female	No Preference
Color:	Red	Black & Tan	No Preference	Other (Please specify
Size:	Mini	Standard	No Preference
Hair:	Short	Long	Wire	No Preference

Do you have children?	Yes No
If yes, what are their ages:
Have you owned Dachshund before?	Yes No
Do you own any other pets?	Yes No
If yes, Please list them here:
Is your yard fenced?	Yes No
Would you be able to provide a vet reference?	Yes No
If yes, the vet's name
The vet's phone number