Print & Fill Out and email heywoods@ev1.net for address.

Tell us about you & your home.

1. Your Name: _____________________________________

2. Age Group(circle one): 20-25 25-35 35-45 45-55 55-65 65 and over

3. Name of other adults in the household:_____________________________

4. Their Age Group(circle one):20-25 25-35 35-45 45-55 55-65 65 and over

5. Address: ____________________________________________________

6. City, State, Zip: _______________________________________________

7. Home Phone: _____________________

8. Work Phone: ___________________ Spouses Work Phone:__________________

9. Cell Phone/optional Phone number:_______________________________

10. Email Address:______________________________

11. Employer: ______________________Spouses Employer:____________________

12. What are the work hours of adults in the home? ______________________

13. Children's Names & Ages: _________________________________________________________________________

14. List any stepchildren, grandchildren or others that visit on a regular basis (& their ages)________________________________________________________________________

15. Do you own or rent your home? _______________

16. If you rent, do you have written permission to have a dog? ____________

17. What type of home do you live in (1 story, 2 story, condo, apartment, farm, other)? (circle one)

18. Do you have a fenced yard? ___________________What kind?__________

19. What height is your fence? _____________

20. Is your fence safe for small dogs? ____________________________

21. Have you checked it for small holes or loose boards? _________________

22. If you move, what will you do with your pet(s)?________________________

23. Where will the dog be when no one is home? _________________________

24. Where will the dog sleep at night? ______________________________

25. Have you ever used a kennel/crate with a dog? __________________

26. What do you think are the most important responsibilities of owning a dog?___________________________________________________________


27. Have you ever taken a dog to basic obedience classes? ________________

28. Do you know about the danger of heartworm infection here in Texas? _____

29. What heartworm preventative will you be using? ______________________

30. Does EVERYONE in your household want a dachshund? _______________

31. Is anyone in your home allergic to animals? __________________________

32. Who will be responsible for the care, feeding, housebreaking and training of the dog? _____________________________________________

33. What circumstances would justify getting rid of a dog? ____________________________________________________________

34. What is your veterinarian's name, address, & phone number? Or the name of the one that you plan to use:____________________________________________________________________

35. How did you find out about our rescue program? ______________________

36. Please list 2 personal references including address and phone number:__________________________________________________________


Tell us about dachshunds.

37. Have you ever owned a dachshund? ___________________________

38. What happened to it? __________________________________________

39. Why are you interested in owning a dachshund? ______________________________________________________________

40. What role will the dachshund play - companion, lap dog, couch potato, running/hiking buddy, guard dog, family member, other? ________________

41. Have you ever owned another breed of dog? ___________________

42. What breeds have you owned and where are they currently? ______________________________________________________________

43. Do you currently own other pets? ________________

44. If so, what kind, sex (spayed/neutered?) and what ages? _____________________________________________________________

45. Where are the above listed animals kept?____________________________

46. Do you know about the different varieties of dachshunds? _______________

47. If so, which do you prefer?_____________________________________

48. Do you know there are two sizes of dachshunds? _____________

49. If so, which do you prefer? _____________________

50. Do you prefer male or female or no preference? _______________________

51. What age dachshund do you prefer? __________________________

52. Would you consider a special needs dog (ie: blind, deaf, seizures, hip displasia) ________________________________________________________

53. Most behavior problems can be treated with training. If necessary, are you willing to get proper training for your dog? ____________________________

54. Please list any other information that you think we should know or any special needs you may have:__________________________________________________________


I certify that the above information is true, and false information may result in nullifying this adoption. I certify that my purpose in acquiring this Dachshund is to have as a family pet, and not for use as research, or breeding. This Dachshund will reside in my home as a pet. I will provide adequate food, water, shelter, training, affection, and medical care. I understand that I will be required to sign a Adoption Agreement and Placement Agreement. This application will become part of these agreements, and any misrepresentation in this agreement will constituted a breach of the Conditions of Adoption and the Placement Agreement. I understand that HDR is a rescue service and is not responsible for the accuracy of information received about the temperaments, habits, or physical condition of Dachshunds available for adoption or that are placed. HDR is not responsible for any damage, accident, or injury resulting from the placement of a Dachshund into my household.

I am in full agreement with these terms of adoption.


Thank you for completing this application and for your interest in our program. We will respond to your application as soon as possible; please rememeber that this organization is staffed totally by volunteers!!

Please print-out & mail application to:
Houston Dachshund Rescue
Attn: Heather Heywood

** Submission of application DOES NOT guarantee adoption of a dog through Houston Dachshund Rescue **