Adoption Application – Mile High Dachshunds Rescue

Please fill out an application for the dachshund you are interested in adopting. We are unable to accept “looking for” applications. We do not keep past applications on file. If you have another animal in your family (dog or cat) they will need to be up to date on their shots and neutered/spayed in order for you to be considered.

Please review the Adoption Contract that you will need to agree to if/when an adoption occurs. Filling out an application doesn’t guarantee adoption.

Mile High Dachshunds Rescue Adoption Application

What is the dachshund's name that you are interested in adopting?(Required)

Personal Information

Name(Required)

First Last

Spouse/Partner's Name

First Last

Address(Required)

Street Address City State ZIP Code

Phone(Required)

Type of phone(Required)

Cell

Home

Work

Date of birth of primary adopter(Required)

Marital status(Required)

Single

Married

Divorced

Widowed

Do you have minor children in your home or visiting regularly?(Required)

Yes

Please list the children's names and ages

Have the children lived with or had experience with pets?

Yes

Some of the childrem

Residence Information

Type of home(Required)

House

Condo/townhouse

Apartment

Do you rent or own?(Required)

Rent

Own

Do you have permission from your landlord to have pets?

Yes

Unknown

Landlord's name

First Last

Landlord's phone

Do you understand and agree to all local zoning regulations and animal control codes and ordinances whether local, county, or state and including any that limit the number of pets at your address?(Required)

Yes

Please initial here that you read and acknowledge the statement about zoning regulations and animal control codes on ordiances.(Required)

Do you have a fenced yard?(Required)

Yes

What is the height of the fence? What material is it made, i.e., wood, chain link?

Current Pet Information

Do you currently have any dogs or cats?(Required)

Yes

How many dogs and/or cats live at your house? Please include the number of each.(Required)

Are all the dogs and/or cats neutered?(Required)

Yes

Please explain why they aren't neutered.(Required)

Are your dogs on a heart worm preventative?(Required)

Yes

I don’t have a dog/only cat(s)

Are all your pets up to date on required vaccinations?(Required)

Yes

Why are they not current on vaccinations?

Have you ever sold, surrendered, or given away any pet to a municipal shelter, an animal welfare group, private rescue or individual person?(Required)

Yes

Please explain the circumstances.(Required)

Have you even had a pet euthanized (put to sleep)?(Required)

Yes

Please explain the circumstances.(Required)

Caring for Your Adopted Dog

How long will you be able to provide a home for your adopted dog?(Required)

How many hours a day will the dog be left alone?(Required)

When no one is home, the dog will be?(Required)

Free in the house

Crate in the house

Outside

Other

What is your plan?

Where will the dog sleep at night?(Required)

What are reasons you would relinquish the dog back to Mile High Dachshunds Rescue?(Required)

Moving

New baby or family member

Chewing

House training problems

Separation anxiety

Can no longer afford

Other

What other reason would relinquish the dog back to Mile High Dachshunds Rescue?

Please understand it may take your adopted dog from two weeks to several months to adjust to its new surroundings. How long will you give the dog as an adjustment period to your other pets, your family members and your lifestyle?(Required)

Do you know the costs, challenges, and care needed for a dog that may live up to 20 years?(Required)

Yes

In the case of an accident or serious illness, are you able and willing to provide veterinary care for the adopted dog that may run from $200 to $1,000 or more?(Required)

Yes

Do you agree to contact and work with MHDR on any behavioral problems that may arise so the issues can be addressed before they negatively impact the bond you have with your new dog?(Required)

Yes

Are you willing to seek out and pay for assistance from a professional dog trainer or behaviorist recommended by MHDR if MHDR is not able to help you resolve the issue(s)?(Required)

Yes

Veterinarian Information

Do you have (or had in the past) a veterinarian?(Required)

Yes

Clinic name(Required)

Veterinarian name(Required)

First Last

Clinic address(Required)

Clinic phone number(Required)

Length of time known(Required)

Personal References (do not use relatives)

Reference #1(Required)

First Last

Address for Reference #1(Required)

Street Address City State ZIP Code

Email for Reference #1

Phone(Required)

Name Reference #2(Required)

First Last

Address for Reference #2(Required)

Street Address City State ZIP Code

Email for Reference #2

Phone for Reference #2(Required)

Date(Required)

Is there anything else that you would like to share with us?