Miniature Pinscher Rescue Houston Adoption Application

Adoption Application

Miniature Pinscher Rescue Houston
Submitting this application does not mean that you are commiting to a dog, nor does it guarantee that you will get a dog. It is a tool to help the rescue identify potential matchs for your family and vice versa.

A successful adoption depends on selecting the dog with the best personality and temperament to match the adopter's needs and expectations. Please help with this process by answering the following questions fully & completely. THANK YOU!
If there is a specific dog you are interested in adopting, please list his/her name(s):
Applicant's Name*
First & Last Name
Applicant's Address*

Street Address

Street Address Line 2

CityState

Zip Code
Applicant's E-mail*
Applicant's Phone Number*

Area CodePhone Number
Phone Type*

CellHomeWork
Best time to call
How long at current address
Occupation
Age
Adult #2: If there is more than one adult in household, fill out the following questions.
Adult #2: Name, Phone, Best time to call, Occupation, Age
Adult #3: If there is more than one adult in household, fill out the following questions.
Adult #3: Name, Phone, Best time to call, Occupation, Age
Who will be primarily responsible for caring for this pet? *
I/We live in a*

Single Family HomeDuplex/TwinCondo/TownhomeTrailerApartment
Do you rent or own this property?*

RentOwn
If renting, provide landlord name and phone number.
Are you planning to move in the near future?*

YesNo
Names and ages of resident children in the home*
Do non-resident children visit and if so, what are their ages
Do you currently have any pets?*

YesNo
If you currently have pets, please list them below being as detailed as possible.
Species, Breed, Name, Male/Female, Spay/Neutered, Age
Please list all deceased pets that you have owned in the past ten years.
Species, Breed, Name, Male/Female, Spay/Neutered, Age at death, Reason for death
Have you ever lost a pet or had a pet die at an early age or due to accident, injury or unexpected illness?*

YesNo
If so, describe the circumstances:
Have you ever had to surrender a pet?*

YesNo
If so, describe the circumstances and give the name and contact number of that person:
Are your dogs presently on heartworm preventative? Or if your dogs are deceased, were they on heartworm preventative while alive?*

YesNo
If so, please list brand used and how often given: *
Please list any exotic pets (birds, reptiles, hamsters, etc.) that you own?
Vet Reference: List your veterinarian and phone number for all animals you have owned in the past ten years. *
Vet name, address & phone number
The name(s) the vet records are listed under if different than applicant's name.
Please Sign Here To Authorize Your Veterinarian To Release Any And All Medical Records On Your Pets To Miniature Pinscher Rescue Houston For Purposes Of This Application (please note by typing your name(s), this is the same as your written signature(s)):
If you have not owned pets in the past ten years, please give the name and phone number for your previous vets.
Please list three personal references. Two should be non-family members.
Personal Reference #1:*
Name, email, address, phone
Personal Reference #2:*
Name, email, address, phone
Personal Reference #3:*
Name, email, address, phone
Do you work outside of the home?*

YesNoOne applicant is home/works from homeWe work different shifts
Where will the pet be kept during the day while no one is home and for how long on average? *
Where will the pet sleep or be kept at night? *
Where will the pet be kept when no one is home (weekends, during errands, etc.)? *
Where will the pet be kept when on vacation? *
Will your pet be crated?*

YesNo
If so, for how long on average and what type of crate do you have or plan on using?
Will the pet be allowed on the furniture with you?*

YesNo
Do you have a securely fenced yard (no loose/rotten boards, no gaps in fencing material or low spots at bottom, etc)? Minpins are natural escape artists and most rescue minpins will jump/climb/dig/chew out if given an opportunity.*

YesNo
If so, describe the fencing material/type and the height:*
Material/type of fence, height of fence
Are all exterior gates locked?*

YesNo
Do you have a doggie door?*

YesNo
Exercise and potty time for the pet will be (check all that apply)*

On lead or leashTie-out or chain/trolleyFenced yard (totally enclosed)Partially fenced areaElectronic/invisible fenceLoose in yardIndoor potty area (peepads, litter box)Other
Do you have a pool, hot tub, spa, pond or fountain?*

YesNo
If so, please describe:
Pool type?*

Above groundIn groundNone
Is the area separately fenced?

YesNo
If not, how will the pet be protected from this area?
Is anyone in your home allergic to dogs?*

YesNo
Does anyone in your home fear dogs?*

YesNo
Does anyone in your home smoke?*

YesNo
Have you discussed this adoption with all members of your household?*

YesNoYes, adults have discussed. Kids don't know yet.
Are you familiar with the Miniature Pinscher breed and the specific care that they require?*

YesNo
When will you be ready to adopt this dog?*

This weekendWithin a weekWithin a monthNot ready yet, just researching
Are you in contact with any other rescues or shelters about a specific dog?*

Yes, application is pendingYes, just an email inquiry, no app yetNo, but I am looking at several dogs onlineNo, I am only interested in this particular dog
We will be speaking to all adult residents to confirm everyone is aware of this application process and wants to have a dog added to the family. Please do not submit an application if you are "trying to talk someone into" adopting this dog or think "once they meet the dog, they will want one" or "I'm getting this dog as a surprise present for them."
What are you looking for temperament and personality wise in a dog. (If this dog is not a fit, we may be able to recommend another based on what you say here.)
How much do you feel you can reasonably afford and would be willing to spend on your dog per year (for things like veterinary care, grooming, quality food, toys, training, pet sitting/boarding, etc)? *
Please take time to think, be honest with yourself and us when answering this question. What are you absolutely NOT wanting to deal with at the time of adoption with a new dog?*

HousebreakingChewingJumpingPulling on leash during walksCounter surfingObedience trainingFear of menFear of womenFear of childrenGrowlingBarkingRough play with my dogHigh activity levelFood/toy aggression/not willing to share with other dogsFood/toy aggression with peopleWhining/cryingBlindnessLimited SightSeparation AnxietyDiabetesSpecial DietLong Term MedicationIncontinence / Leaking UrineGets stressed/carsick when riding in vehicleCan't climb stairs due to age/arthritis/health issuesHeart conditionSkin /Food allergiesTrimming nailsMonthly Heartworm preventativeAnnual heartworm/lyme combo testingI will do whatever it takes to help this dog adjust and work with a trainer to help resolve any training needs.Other
Please take time to think, be honest with yourself and us when answering this question. What are you absolutely NOT wanting to deal with at any time during the life of the dog?*

HousebreakingChewingJumpingPulling on leash during walksCounter surfingObedience trainingFear of menFear of womenFear of childrenGrowlingBarkingRough play with my dogHigh activity levelFood/toy aggression/not willing to share with other dogsFood/toy aggression with peopleWhining/cryingBlindnessLimited SightSeparation AnxietyDiabetesSpecial DietLong Term MedicationIncontinence / Leaking UrineGets stressed/carsick when riding in vehicleCan't climb stairs due to age/arthritis/health issuesHeart conditionSkin /Food allergiesTrimming nailsMonthly Heartworm preventativeAnnual heartworm/lyme combo testingI will do whatever it takes to help this dog adjust and work with a trainer to help resolve any training needs.Other
What would cause you to return a dog?*
What do you feel is a reasonable amount of time for a dog to adjust to life with you/your family?*
What would you do if you discovered after adoption (at any time during the life of the dog) if your vet diagnosed an expensive health condition?*
Do you plan to get pet health insurance?*

YesNoI wasn't aware this was available. I will look into it.
What type and brand of dog food do you currently feed or plan to feed?*
Grooming (please check all that apply)*

We use a professional groomer for baths and nail trimsWe trim dog nails ourselves at homeWe don't trim our dog's nailsWe bathe our dogs at home once a weekWe bathe our dogs at home once a monthWe bathe our dogs at home once every few months or whenever their coat feels dirtyWe don't bathe our dogWe check ears weekly for infection/yeast/mitesWe clean teeth using home methodsWe take our dogs to the vet for dentals whenever the vet recommends this is needed
Do you have any additional comments, questions or concerns? Anything else you would like us to know to help match you up to a dog?
Do you agree to return this dog to Miniature Pinscher Rescue Houston if you are unable to keep it for any reason?*

YesNo
I understand that completing this application does not guarantee I will be allowed to adopt a dog, and that the application is a tool to help Miniature Pinscher Rescue Houston (MPRH) determine if a dog and my family are a good fit for each other. I acknowledge that all information provided on this form is true and correct. I understand that any misrepresentations may result in my not being approved and/or removal of the adopted dog from my possession. I also certify that I have never been convicted of animal cruelty or neglect.

I agree to allow a representative from MPRH to contact my vet for a reference and also agree to allowing a home visit prior to adopting a dog. If I am approved to adopt a dog, I agree to pay a non-refundable adoption fee and hand sign an adoption contract at the time of adoption.

I understand that all dogs adopted from MPRH will be spayed/neutered, heartworm tested and treated if positive, current on rabies by law, and microchipped prior to adoption.
Please read the above, check this box, sign, and click Submit.*

I/We have read and understand all of the above.
Applicant's Signature*
Co-Applicant's Signature
Signature date*
Miniature Pinscher Rescue Houston reserves the right to reject any application based on information obtained during this screening process. Please understand that our primary goal is the health, happiness, and safety of our rescued dogs.
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