Dog Dachshund you are interested
1.Are you 21 years or older?
2. Your full
City, State, Zip________________________________________________________
Day PH# _______________Cell#_________________ Hm#___________________
3. How long have you
lived at above address? _____________________________
Are you planning to move in the next 6 months? Yes/No
Do you rent/own/live with relatives/live with roommate? Circle one
If you rent, does your landlord/roommate allow pets? Yes/No
Name and phone # of landlord or relatives, .roommate that you live with:
Where will the animal stay when you are not home? Loose
otherwise restrained inside_______________, Loose outside __________
Kennel run _______________, Fenced Yard _____________, Tied/chained outside
If you have a fence, type? Chain link/ Wooden / Barbed wire /
If you have a fence, how high is it? 3ft 4 ft 5 ft 6 ft 8 ft
Is the pet for your family? Yes/No if not, is it a gift? Yes/No
How many people live in the adopting household?
Do they all know you are adopting this animal? Yes/No
Do you have children? Yes/No If so, what are their ages?
If not, do children visit the home often? Yes/No ages?
Do you own other dogs or cats? Yes/No
If yes, please describe breed, sex, and age of each:
If not altered, why not?
Are they current on yearly vaccinations? Yes/NO
Are they currently on heartworm prevention? Yes/No What type?
Does your city, subdivision, landlord have any restrictions on the number
of pets you
If so what is the limit? ___________________________________
How many cats or dogs have you owned in the last 7 years?
Dogs _______________ Cats _____________ What happen to them?
22 Your Veterinarianís
name and phone # ________________________________________
Do you give
permission for me to contact? Yes/NO Initials _______________________
How many hours a day will the animal spend alone?
Where will it stay when it is alone? ___________________________________________
Where will it stay during the day? ____________________________________________
Where will it stay at night? __________________________________________________
What problems would make you return the animal? Barking / housetraining/
jumping/ shyness/ digging/shedding/ other-explain
To help resolve these problems, are you willing to: Use a crate / Take an
Class / Do nothing
Check the traits that are most important to you in a pet:
______Good with Children _________Low energy _______ High energy
______ Good with dogs _____ Good with cats _________ Travel well
______ Coat length _______ Wonít need obedience training
______ Doesnít chew, dig, jump _______ Will run with jogger owner
Under what other possible circumstances would you return the animal:
Move / New Baby / Divorce / High cost of animal care / Personal illness / Other:
27. Are you willing to
sign a legally binding Contract that promises that you will return
(dachshund) to Judy
K. Burns if at anytime during its life, you find yourself unable to.
I represent that the above
information I provided on this form is the truth to the best of my
knowledge and belief. Any
falsification or omission of
any question of any of the above information will result in automatic refusal of
adoption or confiscation
of the adopted animal.
Judy K. Burns has the right to
deny the adoption of any dachshund pet for any reason. My objective is to assure the
welfare of the pet. I
will contact you if the application is approved.
__________________________________________ DATE ______________