How did you hear about us?


1. Name, age and relationship of those residing with you.

2. Your age?

3. Do you often have other people visiting your home?
Yes No

4. Grandchildren?
Yes No

5. Other children?
Yes No

6. Is everyone in the residence and family agreeable to adopting a dog?
Yes No

7. What kind of dog are you interested in adopting?
Doberman  Dachshund  Other

8. Have your children (if applicable) been exposed to the kind of dog you wish to adopt?
Yes No Not Applicable

9. Are you willing to teach everyone in your home, and all visitors, the proper care and treatment of your new dog?
Yes No

10. Are you willing to teach young children the proper care and treatment of your new dog?
Yes No

11. Are you willing to always monitor young children with your new dog?
Yes No

12. Even a dog that has proven reliable with young children?
Yes No

Are you willing to?

13. Read books about the breed of dog that your adopting, and discuss the breed with your veterinarian, animal behaviorists, and other professionals in order to better understand the breed and their special characteristics?
Yes No

14. Take the dog to a veterinarian at least once a year for a physical exam and shots?
Yes No

15. Take the dog to a veterinarian when ill?
Yes No

16. Welcome the dog into your family as a permanent member?
Yes No

17. Return the dog ONLY to Brenda Borelli and Las Vegas Doberman and Dachshund Rescue if you decide he/she cannot be a member of your family?
Yes No

18. Do everything within your power, and with the help of your veterinarian, and/or other professionals to ensure that the dog has a long, healthy life?
Yes No

Have you given careful consideration to all the following?

19. Financial obligations of responsible pet ownership?
Yes No

20. Special needs, time and patience involved with rescue dogs?
Yes No

21. Who will care for the dog, and where will the dog be kept?


22. Have you ever owned a dog?
Yes No

23. Have you ever owned the breed of dog you are requesting to adopt?
Yes No

24. Why do you want to adopt a rescued dog at this time?


25. Do you currently own any other pets?
Yes No

26. If yes, then please provide name, species, breed and age of each:


27. Have ALL the animals listed above (if any) been spayed or neutered?
Yes No

28. If you have previously owned dogs, what happened to those no longer living with you?


29. What do you know about the characteristics of the breed you are requesting?


Only answer questions 30-32 if you are requesting to adopt a dachshund, otherwise continue on to question 32:

30. Are you familiar with the unique personality of a dachshund?
Yes No

31. Are you aware that purebred dachshunds can have a predisposition to back problems, weight gain, and house training problems?
Yes No

32. Are you aware that purebred dachshunds are not the best choice for families with very young children?
Yes No

Are you willing to adopt a dog that is:

33. Older?
Yes No

34. If you checked yes above, what ages are you willing to consider?
Over 10 years   7 to 10 years  5 to 7 years

Are you willing to adopt a dog that is:

35. Abused?
Yes No

36. Not reliable with children?
Yes No

37. Physically handicapped?
Yes No

38. Requires ongoing medication?
Yes No

39. Requires continued house training?
Yes No

40. Would you consider adopting a pair of dogs in the case that two dogs shouldn't be separated and need to be placed together?
Yes No

41. Type of residence?
House Condominium Apartment

42. Own or Rent?
Own Rent

43. If renting, is your landlord agreeable to you having a rescued dog of the breed you are requesting?
Yes No Not Applicable

44. Do you have a yard?
Yes No

45. If you do, is it fenced?
Yes NoNot Applicable

46. Do you have a exercise program for the dog?
Yes No

47. Do you have a swimming pool or spa?
Yes No

48. If you do, is it safety fenced?
Yes NoNot Applicable

49. If not safety fenced, do you have a pool alarm system?
Yes No Not Applicable

50. Are there stairs in your residence?
Yes No

51. Where will the dog be kept during the day?


52. How many hours a day will the dog be left home alone?


53. Where will the dog sleep?


54. Who will take care of the dog while your at work?


55. Would you be willing to take the dog for obedience training if needed?
Yes No

56. Are you familiar with the necessary shots (annual)?
Yes No

57. What do you intend to feed the dog?


58. If needed, how will you housebreak the dog?


Please list preferences:

59. Color:
Red
Black and Tan
Other
No Preference

60. Coat: (only for Dachshunds)
Smooth
Long
Wire
No Preference

61. Size: (only for Dachshunds)
Miniature (11 lbs and under at 12 months of age)
Tweenie (that unrecognized size between 11 and 18 lbs)
Standard (18 lbs and over at 12 months of age)
No Preference

62. Gender:
Male Female Either

63. Preferred age range:


64. Anything you would like to add that would help in determining the correct animal for your living situation?


Name, address and telephone number of:

65. Landlord: (if applicable)


66. Veterinarian:


67. References:
1.
2.
3.

Note: Failure to provide telephone numbers for landlord (if applicable), veterinarian and references will result in your application being delayed. If none please explain why.

68. If you are applying to adopt a specific animal, please enter the name of the animal you are interested in.




The information provided in the application (in its entirety) is true to the best of my knowledge as of the date on this application. I agree that submission of this form will constitute a legally signed document.

(enter your name to "sign")