Wufoo

CTDR Adoption Application

A home visit is required before an adoption is final. Do not apply for a dog to give as a gift or to use as a hunting dog. CTDR does not adopt to homes where a pet has been abandoned in the past, where pets have not been kept up-to-date on their vaccinations and heartworm prevention, or where there are currently unsterilized adult dogs or cats in the home.

Please review our GUIDELINES before submitting your application.
You may also want to review our ADOPTION PROCESS.
Thank you for your interest.

**Please fill in all fields. If a field does not apply to you, please write n/a. The form will not accept blank fields.**

Type of application
Date / MM / DD YYYY
Applicant's name * First Last
Applicant's address *

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Home/Primary Phone * - (###) - ### ####
Cell Phone - (###) - ### ####
Work Phone - (###) - ### ####
When/where is the best time to call? *
Email *
How did you hear about us? *
Are you working with any other rescue groups? *
Name of dog(s) you are interested in?
For whom are you adopting? *
Names and ages of those living in the home? *
How often do you have other people visiting your home? *
How often do grandchildren visit? *
How often do other children visit? *
Is everyone in the home and family agreeable to adopting a dachshund? *
Have your children been exposed to dachshunds?
Are you willing to teach everyone in the home and all visitors the proper care and treatment of a dachshund? *
Are you willing to always monitor young children around a dachshund? Especially around a dachshund that has proven reliable around young children? *
Are you willing to:

-Read books on the breed and discuss dachshunds with your veterinarian, animal behaviorists, and other professionals in order to better understand the dachshund breed and its special characteristics? *
-Take the dog to a veterinarian at least once a year for a physical exam, shots and heartworm check? *
-Take the dog to a veterinarian when ill? *
-Welcome the dog into your family as a permanent member? *
-Maintain heartworm preventive medications throughout the dog's life? *
-Do everything in your power, and with the help of your veterinarian and/or other professionals, to ensure that the dog has a long, healthy life? *
Have you given careful consideration to the following:

-Financial obligations of responsible pet ownership? (Often a minimum of $200 per year.) *
-Special needs and time and patience involved with rescue dachshunds? *
Have you ever owned a dog? *
Have you ever owned a dachshund? *
Why do you want to adopt a rescued dachshund at this time? *
Do you currently own any other pets? Please list name, species, breed, and age of each: *
Are your current pets spayed or neutered? *
What do you enjoy most about your current animal/animals? *
What do you enjoy least about your current animal/animals? *
Please list previous pets and the reasons why they are no longer with you: *
Are you familiar with the unique personality of the dachshund breed? *
Are you aware that purebred dachshunds can have a predisposition to back problems, weight gain and housetraining issues? *
Are you aware most purebred dachshunds are not the best choice for families with young children? *
Are you willing to adopt a dachshund that is:

-Younger? * Yes No Possibly
Older? * Yes No Possibly
Abused? * Yes No Possibly
Requires medications? * Yes No Possibly
Requires housetraining? * Yes No Possibly
Type of residence *
If renting, is landlord agreeable to adoption? *
Do you have a yard? *
What type of fence?
If not fenced, how will you exercise or potty your dachshund?
Do you have a pool? *
Are there stairs in your home? *
Does anyone in the household smoke? *
If yes, do they smoke inside the home?
Does anyone in your home have allergies? If yes, please explain. *
Who will care for the dog and where will the dog be kept when someone is home? *
Where will the dog be kept when no one is home? *
How many hours a day will the dog be left alone? *
Where will the dog sleep? *
Who will care for the dog while you work? *
Would you be willing to take the dog for obedience training if needed? *
Are you familiar with vaccinations as well as heartworm testing and prevention? *
Date your pet(s) last had vaccination(s): *
What heartworm prevention do you use? *
Are you familiar with flea and tick treatment and preventive? *
What do you intend to feed your dog? *
Please list any reasons you can think of that a dog could not become a permanent member of your family. Please be honest with yourself. There are always very legitimate reasons and this will help us to place a dog with you that suits your home.
Please list preferences:

-Color *
-Age * Puppy Adult Senior No preference
-Gender * Male Female No preference
-Coat * Smooth Long Wire No preference
-Size * Mini (11 lbs and less) Tweenie (12 lbs to 15 lbs) Standard (16 lbs +) No preference
-Preferred energy level * Low Medium High No preference
We require that any pets currently in your home be spayed/neutered and be current on their vaccinations. We require dogs in your home to be on heartworm prevention. We will be contacting your vet for a reference. Please give the name, address, and phone for your veterinarian.

REQUIRED! We cannot process your application without this information.

Veterinarian name *
Veterinarian address *

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Veterinarian phone * - (###) - ### ####
Please give the name and phone for your landlord. If you are a homeowner, please write "self." *
Please give 3 references (name, address, phone) that are not related to you:

Reference 1 *
Reference 2 *
Reference 3 *
By typing your name below, you signify that you have filed this application and understand all that is contained within.

The information provided in this application is true to the best of my knowledge as of the date first shown on this application above.
Signature *
CTDR is staffed by volunteers. Please be aware that it can take up to a month for us to process your application. Thank you.

NOTE: Press the SUBMIT button only once!
Do Not Fill This Out

Wufoo

CTDR Adoption Application

CTDR is staffed by volunteers. Please be aware that it can take up to a month for us to process your application. Thank you.