Dixie Dachshund Rescue

    
1)                              Select one Male Female                                     Select one yes no                                Select one 1 2 3 4 5 6 7 8 9 10 11-15 16-25

2)                              Select one Male Female                                     Select one yes no                                Select one 1 2 3 4 5 6 7 8 9 10 11-15 16-25

3)                              Select one Male Female                                     Select one yes no                                Select one 1 2 3 4 5 6 7 8 9 10 11-15 16-25

Other Comments about your pet (s) and/or list additional pets:
 
Are your pet (s) up-to-date on shots: Select one yes no        

Are your pet (s)  tested for heartworms:  Select one yes no

Are your pet (s) on heartworm preventative: Select one yes no

*Note* Answer the following 3 questions only if you answered no to the 3 questions above.

Are you familiar with the necessary annual shots?: Select one yes no

Are you familiar with heartworm testing and prevention?: Select one yes no

Are you familiar with flea/tick treatment and prevention?: Select one yes no

Would your pet (s) accept a new dog?: Select one yes no

Have you had pets in the past?: Select one yes no
 

If so, please tell us about  them:

Do you own your own house?: Select one yes no
 
*Note* If renting, we require the landlord's contact information to verify that dogs are allowed.

Landlord's name:

Landlord's full address: 

Landlord's Telephone Number:

*Note* Dixie Dachshund Rescue, Inc. has a total restraint policy:

Do you have a securely fenced yard?: Select one yes no

What type and height is the fence?:

If no fence, how are your animals taken out for potty breaks?

Where and how will the dachshund be exercised?:

Do you have a doggie door?: Select one yes no

Will the dachshund be supervised when outside?: Select one yes no

Do you have a pool?: Select one yes no

Are there any stairs in your residence?: Select one yes no

Where will the Dachshund sleep at night and is the doxie allowed to sleep in bed with you or a  family member?:

What are the working hours of the adults in the home:

Where will it be kept when left alone?:

How many hours per day will the dachshund be left alone?:

Who will care for the dachshund while you are at work?:

Who will care for the dachshund when you go on vacation?:

Who will care for the dachshund if you are away for the weekend?:

Would you adopt a pair of dachshunds, if they could not be separated?: Select one yes no

Would you be willing to take the dachshund for obedience training?: Select one yes no

What type of  heart worm and flea/tick prevention will you use?:

What do you intend to feed the dachshund?:

Will the dachshund have access to fresh water at all times, and how?

Dachshunds vary greatly in temperament, personality, and activity level.
What characteristics would you find undesirable in a foster Dachshund?:

Would you accept a dachshund:

That is older?: Select one yes no

Has been abused?: Select one yes no

Is not reliable with children? : Select one yes no

Has a physical handicap?: Select one yes no

Is not housebroken?: Select one yes no

Up to what age would you be willing to consider?: Select one up to 2 up to 5 up to 7 up to 10 age is not an issue

If needed, how will you housebreak the dachshund?:

Would you accept a pregnant dachshund and be willing to do whelping?:

Would you be willing to accept a dachshund that is recovering from medical treatment and may need foster care 2 to 4 months or longer?:

Would you be willing to foster a puppy or puppies and all that is entailed with fostering a puppy (socializing, housebreaking, etc.)?:

Please describe any experience you may have in training and/or Rehabilitation work with animals:


All fosters must be socialized, housebroken if they are not already housebroken, and many need help breaking bad behaviors. Are you willing to do this as a foster parent?:

If you own other animals, or have owned other animals in the past 3 years, please fill out the following section:

Veterinarian's Name:

Veterinarian's full address:

Veterinarian's telephone number:

How long have you been a client?:

REFERENCES:

Reference No. 1 (Do not list any relatives or people living with you)

Name:

Home Telephone:

E-mail address:
 
Reference No. 2 (Do not list any relatives or people living with you)

Name:

Address:

Home Telephone:

E-mail address:

Select one yes no <

If yes, please list the name of the organization and the contact person you are working with:

Contact person name & number:

Have you ever been turned down by any rescue organization for adoption of a rescued animal?: Select one yes no

If so, why?:

How did you hear of Dixie Dachshund Rescue?