Miniature Pinscher Rescue Houston Adoption Application

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

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

Do you rent or own this property?

If renting, provide landlord name and phone number.

Are you planning to move in the near future?

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?

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?

If so, describe the circumstances:

Have you ever had to surrender a pet?

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?

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?

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?

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?

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.

If so, describe the fencing material/type and the height:

Material/type of fence, height of fence

Are all exterior gates locked?

Do you have a doggie door?

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

Do you have a pool, hot tub, spa, pond or fountain?

If so, please describe:

Pool type?

Is the area separately fenced?

If not, how will the pet be protected from this area?

Is anyone in your home allergic to dogs?

Does anyone in your home fear dogs?

Does anyone in your home smoke?

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

Are you familiar with the Miniature Pinscher breed and the specific care that they require?

When will you be ready to adopt this dog?

Are you in contact with any other rescues or shelters about a specific 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?

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?

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?

What type and brand of dog food do you currently feed or plan to feed?

Grooming (please check all that apply)

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?

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.

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.