CCDR!
Coast to Coast Dachshund Rescue 
Adoption Application 
http://www.c2cdr.org 
Thank you for choosing adoption. The adoption fees vary according to age of the dog. 

This form is set for delivery to the adoption committee and will be forwarded to the representative in your area or to the foster representative of the dog you are inquiring about.  CCDR gets an enormous amount of inquiries and will respond to your submittal in as soon as possible. If you have any specific questions you may email: adoption@c2cdr.org - Thank you CCDR


It is important to answer all questions. Answers left blank may jeopardize your ability to adopt from us. Use your tab key to jump to the next question. If you accidentally hit the "enter" key you will "send" the form and it will be incomplete. If you do "send" the form and see the "thank you" screen, click "back" on your browser to return to the form. Your answers will still be there. You must be at least 21 years of age to fill out this form.

If you are applying to adopt a specific dog, please enter the name of the dog you are interested in here.
What is the email address of the representative that has this dog listed?


If you are currently working with a CCDR member who is helping you find a dog, please provide their name. 
Name: 
What is the email address of the CCDR member you are working with?

*Your E-Mail:
Your Name:
Today's Date:
Address:
City:
State    Zip Code 
Home Phone:
Cell Phone
Work Phone
Extension: 
 


Age of applicant

Name, age and relationship of those residing with you.

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

Grandchildren?
YesNo

Other children?
Yes No 

Is everyone in the residence and family agreeable to adopting a dachshund?
Yes No

Have your children (if applicable) been exposed to dachshunds?
Yes No Not applicable

Are you willing to teach everyone in your home, and all visitors, the proper care and treatment of a dachshund?
Yes No

Are you willing to teach young children the proper care and treatment of a dachshund?
Yes No

Are you willing to always monitor young children with the dachshund?
Yes No

Even a dachshund that has proven reliable with young children? 
Yes No

Are you willing to:

Read books about dachshunds, and discuss the dachshund breed with your veterinarian, animal behaviorists, and other professionals in order to better understand the dachshund breed and their special characteristics?
Yes No

Take the dog to a veterinarian at least once a year for a physical exam, shots, and heartworm check?
Yes No

Take the dog to a veterinarian when ill?
Yes No

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

Return the dog ONLY to Coast to Coast Dachshund Rescue if you decide that he/she cannot be a member of you family?
Yes No

Maintain heartworm preventative medications throughout the dog's life?
Yes No

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 of the following:

Financial obligations of responsible pet ownership?
Yes No

Special needs and time and patience involved with rescue dachshunds?
Yes No

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

Have you ever owned a dog? 
Yes No

Have you ever owned a DACHSHUND?
Yes No

Why do you want to adopt a rescued dachshund at this time?

Do you currently own any other pets?
Yes No

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

If you have other dogs and cats, are they all spayed or neutered?
Yes No 

Coast to Coast Dachshund Rescue has a very strict spay/neuter policy requirement. This policy can be located at http://www.c2cdr.org/spay_neuter_policy.html

If you have an unaltered dog or cat, please explain in detail why the animal has not been altered.

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

What do you know about the characteristics of the dachshund breed?

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

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

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 dachshund that is:

Older?
Yes No

If you checked yes above, what age are you willing to consider?:
 

Over 10 years 7 to 10 years 5 to 7 years

Are you willing to adopt a dachshund that is:

Abused?
Yes No

Not reliable with children? 
Yes No

Physically handicapped?
Yes No

Requires ongoing medication other than heartworm preventative?
Yes No

Requires continued house training?
Yes No

Would you consider adopting a pair of dachshunds in the case of dogs that should not be separated and need to be placed together?
Yes No

Type of residence:
House Condominium Apartment 

Own or Rent?
Own Rent

If renting, is landlord agreeable to you having a rescued dachshund?
Yes No Not applicable

Do you have a yard?
Yes No

Fenced?
Yes No

If not fenced, do you have an exercise program for the dog?
Yes No

**If you do not have a fenced yard, how would you exercise your dog? This is a required answer if you do not have a fenced yard. 

Are there stairs in your residence?
Yes No

Where will the dog be kept during the day?

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

Where will the dog sleep?

Who will take care of the dog while you work?

Would you be willing to take the dog for obedience training if needed?
YesNo

Are you familiar with the necessary shots as well as heartworm testing and preventative? 
Yes No

Are you familiar with flea and tick treatment and prevention?
Yes No

What do you intend to feed the dog?

If needed, how will you housebreak the dog?

Please list preferences:

Color:

Red

Black and Tan

Other

No Preference 

Coat Type:

Smooth

Long

Wire

No Preference

Size:

Standard (20 lbs and over at 12 months of age)

Miniature (11 lbs and under at 12 months of age)

"Tweenie" ("oversized" mini between 11 and 20 lbs)

No Preference

Gender: Male Female No Preference

Preferred age range:



Important: Is there anything you would like to add that would help in determining the correct animal for your living situation? Please tell us what you'd like in a dog so we may find the correct match. If you require a dog that is totally housebroken, please be honest so we do not tell you about a dog that needs some work on housebreaking. We want our dogs to be the best match for your home. 



Name, address and telephone of: Landlord (if applicable)

*Veterinarian: 
Veterinarian's name, Clinic Name, Address, Phone number and email address

*References:

*Reference 1

Name:
Street Address:
City
State
Zip
Phone Number
Email Address
Relationship to you

*Reference 2 (Not related to you)
Name:
Street Address:
City
State
Zip
Phone Number
Email Address
Relationship to you


*Reference 3 (Not related to you)
Name:
Street Address:
City
State
Zip
Phone Number
Email Address
Relationship to you


Addtional Comment section: 
Please review your application and make sure that you have filled in all the fields. These fields MUST be completed or else your application cannot be processed. 
  1. Your email address
  2. Your Veterinarian's information
  3. Reference 1
  4. Reference 2
  5. Reference 3
Please scroll back up and make sure these fields are filled in.
The information provided in this application (in its entirety) is true as of the date on this application and I understand my application can be denied if false information is given. I give permission to have my references checked, am at least 21 years of age and agree that submission of this form will constitute a legal document once submitted.(enter your name here to "sign")
If you want to print out this application, click the "print this page" button BEFORE you submit the application.