Form

Miniature Schnauzer Rescue Service of New England

In an effort to guide us in identifying a compatible rescue dog for you to adopt, please complete this questionnaire completely and as honestly as possible. Please fill in the appropriate answers after the questions! Thank you!

Name:

Email:

Address:

Phone:

Are you adopting this dog for yourself or for someone else (such as a gift) Please explain:

Any other residents in home?

Spouse/Roommate Name:

Do you have children?

Anyone in household retired?

If yes, who?

Please enter your age:

EMPLOYMENT

Applicant employer's name:

Applicant employer's address:

Work Phone Number:

If Part Time, How many hours per week?

Do you live in a:

RESIDENTIAL INFORMATION

Do you:

Fenced Yard?

Type of Fence:

If you rent, does your landlord allow pets?

May we contact your landlord?

Landlord Name:

Do you currently have any other pets?

If yes, how many?

Dogs - List breed, sex and ages

Cats - List ages and declawed?

Other?

Is there any situation you would let your rescue schnauzer off leash?

If yes, please explain (park, back yard, etc.)

Where will your new dog spend most days?

Where will your new dog spend most nights?

How will your new dog get exercise?

(Running in yard, walks on leash, dog park?)

Do you have a regular Veterinarian?

May we contact your Veterinarian?

Veterinarian's Name, Address,

Clinic Name and Phone number:

3 Personal References (e.g. Groomer, Pet sitter, Co-worker, Neighbor, Friend - NO relatives please!)

Briefly explain why you would like a miniature schnauzer:

Do you have any questions or comments?:

Information about the dog you would like to adopt (as appropriate)

Gender:

Age:

Color :

Ear:

Breed:

Are you interested in adopting a specific dog from MSRS of NE?:

If yes, please give dog's name and reason:

Do you have any special requirements?

(Good with Children, Cats, Birds, other dogs - Etc.)

Would you consider adopting a dog with special needs?

If yes, level of special needs ? (Minor or Major)

Are you financially prepared to provide care and upkeep for a dog at this time (about $600.00 per year)?

Miniature Schnauzer Rescue Service of New England is a not for profit organization; all donations go towards the care of our dogs. We do not get large numbers of schnauzers into our rescue program and we usually have a waiting list for adoption. Most of our rescue dogs are middle-aged (6-9 years old) and are housetrained.

All dogs are spayed/neutered prior to placement, and we bring them up to date on shots, groom them, and take care of basic medical needs such as heartworm screening, dental cleaning and cyst removal.

Adoption fees are donations to Schnauzer Rescue, not payment for value received, and are primarily based on the age and health of a particular dog and our expenses. Donations for senior and special needs dogs are generally $50 - $100 while adoption fees for our other rescues normally range from $100 - $400.

Completion of MSRS of NE Adoption Application does not guarantee approval.

All dogs are subject to prior adoption.

I ascertain that I have answered all of the above questions truthfully and to the best of my knowledge and that the above information is correct. I hereby give my permission to contact the references I have provided.

Enter Name:

Date:

Miniature Schnauzer Rescue Service of New England, 190 Thompson Rd, Webster, MA 01570

Questions: Please call MSRS of NE - 508-949-2012

Press "submit" to send your application

Ages of Children:

Position:

Do you work full or part time?

Landlord Phone #:

Name:

Name:

Phone:

Address:

Phone:

Address:

Name:

Address:

Phone:

Example of special needs: Minor: Arthritis, bladder stones, special diet from vet required, medication controlled minor illness. Major: Blind, Diabetic requiring insulin injections, epileptic, unsocialized or poor temperament.

Relationship:

Relationship:

Relationship: