Surrender Application

Contact Information

How did you hear about Nebraska Dachshund Rescue?
Please enter a Referral Name, other Rescue Organization, Search Engine, Petfinder, Event you attended, from our Facebook page, etc... *

Why are you considering surrendering your dachshund to Nebraska Dachshund Rescue? *

First Name *

Last Name *

Shelter, Rescue Organization, or Kennel

Email *

Address: *

City *

State *

Zip *

Home Phone *

Business Phone

Cell Phone

General Dog Description

What is the dog's name? *

Dog has had this name all its life

Dog was just given this name

Name - Name -

Is the dog a purebred dachshund? *

Yes

No

If No, what is the mix? If No, what is the mix?

Gender?
*

Male

Female

Age? If you are unsure, please give your best estimate.
*

Color and markings?
*

Coat type?
*

Smooth

Long Hair

Wire Hair

What is the dog's size?
*

Small - less than 10lbs

Medium - 10-20lbs

Large - 20-30lbs

If you know dog's exact weight, please enter it here If you know dog's exact weight, please enter it here

Dog Behavioral Information

It's very important that we are aware of any and all behavioral issues ahead of time. We select foster families based on the specific needs of each dog.

Is the dog aggressive towards humans? *

Is the dog aggressive towards other animals? *

Does the dog have other aggressive tendencies? *

Is the dog potty-trained? *

Has the dog ever bitten anyone?
*

Yes

No

I Dont Know

Does the dog have fear-based behavioral issues that we should know about? *

Does the dog have other behavioral issues that we should know about? *

Yes

No

I Dont Know

Please describe other issues - Please describe other issues -

Vetting Information

It's very important that we are aware of any and all health-related issues ahead of time. We select foster families based on the specific needs of each dog. And we also select certain vets based on their specialties.

Is the dog spayed or neutered?
*

Yes

No

I Dont Know

Is the dog current on vaccinations? *

Yes

No

I Dont Know

Some (Please List) Some (Please List)

Has the dog been tested for Heartworms?
*

the dog has been tested and is heartworm NEGATIVE

the dog has been tested and is heartworm POSITIVE

the dog is currently on heartworm preventative

the dog has NOT been tested for heartworms

I Dont Know

Does the dog have any other outstanding health issues we should know about? *

Yes

No

I Dont Know

If Yes, please describe health issues If Yes, please describe health issues

Who is the dog's current vet?
*

I Dont Know

Vet Name & Ph Number Vet Name & Ph Number

Location and Transport

Is the dog in danger of being euthanized?
*

Yes

No

I Dont Know

Where is the dog currently staying?
*

With current owner

At a Shelter

Puppy Mill Surrender

Is the dog's location the same address you entered above? *

Yes

If No, what is the address where dog is located? If No, what is the address where dog is located?

If location is outside of the Omaha-Coucil Bluffs area, are you willing to help transport?

Yes

No