FIRST AND LAST NAME

ADDRESS

CITY

STATE

ZIPCODE

HOME PHONE

EMAIL

I AM ADOPTING FOR  MYSELF   MY FAMILY   A FRIEND   A RELATIVE

Please list the residents in your house: Spouse/Roommate Children  Other (describe)

List Children Ages

Please list any other children that your rescue will come in contact with (grandchildren, neighbors, etc.) and their approximate ages 

Your approximate age range  18-29    30-49   50-65   66-74   75+

Applicant’s Employer (Indicate none or retired if applicable)

Position (occupation)

Hours per week

Spouse/Roommate’s Employer's name 

Position (occupation)

Hours per week

Is anyone home during the day?Yes  No

List hours your dog will be alone 

How many days of the week? 

I live in an (describe - eg. apt., condo, home, mobile home)   

I own my home Yes  No

If you  rent, please list name/phone of Landlord to verify pets allowed

Is your yard securely fenced (i.e. so that a dog will not be able to get through it, jump over it, etc.)? Yes  No

If yes, please describe height, material, etc. 

Have you ever owned a schnauzer?  Yes  No

List current pets: Dogs (list breeds, sex, ages)

Briefly describe your pet's personality (energetic, alpha, submissive, etc.)

Are your pets spayed or neutered?  Yes  No

Do you have a cat or cats? Yes  No

Other (describe)

List your former pet(s) 

What happened to them?   list how old-  eg.  ran away, gave away, hit by car, died of illness (please describe)

My new dog will get exercise   running in the fenced yard  walking on leash   dog park   playing inside  other ( please describe)

Will you tie your new dog out in the yard?  Yes  No

If yes, what will you use? 

Do you have an in-ground swimming pool? Yes  No

Is it fenced separately? 

Do you use an electric or invisible fence?  Yes  No

Do you have a doggie door? Yes  No

Will you leave your dog loose outside or allow him/her to walk off leash?  Yes  No

Your dog will spend days: (eg. crated, in house, outside, with you, etc.)

Your dog will spend nights: (eg. crated, in house, outside, with you, etc.)

Please describe what you will do with your dog when you go away  (eg.dog will stay home with a petsitter, stay with a relative, be boarded at a kennel, go with you   

Briefly explain why you would like a miniature schnauzer

Do you have a regular veterinarian?  Yes  No

Name of Vet and Clinic

Address 

Phone number 

Do you have an alternate vet or vet specialist you have used?  Yes  No

Name of Vet and Clinic 

Address

Phone number

Personal references (Please NO RELATIVES - groomer, pet-sitter, co-worker, friend, neighbor, etc.):

NOTE: two are REQUIRED, three if no vet reference given

Name #1  

Relationship

Address 

Phone number

E-mail

Name #2

Relationship

Address

Phone number

Email

If no veterinary reference, please provide a third personal reference:
Name #3

\Relationship

Address

Phone number

Information about the dog you would like to adopt, as appropriate:

Do you have preferences?  Yes  No

If you answered yes, please indicate your preferences (check all that apply)

Gender preference: MALE  FEMALE  EITHER

Ear Preference  CROPPED EARS   NATURAL EARS   EITHER:

Age range (check all that apply)   Puppy  1-5   6 or older  Any age

Breed preference   PUREBRED    SCHNAUZER-MIX   EITHER:

Special requirements   HOUSETRAINED   GOOD WITH KIDS  DOGS   CATS

NON-SHEDDING   HYPOALLERGENIC  

SIZE (describe)

OTHER (describe)

ARE YOU INTERESTED IN ADOPTING A PAIR? 

NO  YES   MAYBE  

Personality preferences  PLAYFUL   LAPDOG  QUIET  ACTIVE   COUCH POTATO  

I AM INTERESTED IN A SPECIFIC DOG NAMED

BECAUSE

I AM WILLING TO ADOPT A PET WITH

BLADDER STONES  DIABETES   DEAFNESS   BLINDNESS

WILL CONSIDER SPECIAL NEEDS CASE BY CASE

           ****Adoption Application is subject to approval****

DONATION: We request a donation for each dog placed ranging from $50-$350 dependent upon age.

Please realize that dogs need vet care throughout their lives, including yearly vaccinations, heartworm and flea/tick preventative meds,

etc.  If these terms are acceptable to you,  please indicate your acceptance by signing below:

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