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

City State

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

Area Code Phone Number
Phone Type *

Cell Home Work
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 Home Duplex/Twin Condo/Townhome Trailer Apartment
Do you rent or own this property? *

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

Yes No
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? *

Yes No
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? *

Yes No
If so, describe the circumstances:
Have you ever had to surrender a pet? *

Yes No
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? *

Yes No
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? *

Yes No One applicant is home/works from home We 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? *

Yes No
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? *

Yes No
Do you have a securely fenced yard? Minpins are natural escape artists. *

Yes No
If so, describe the fencing:
Material/type of fence, height of fence
Are all exterior gates locked? *

Yes No
Do you have a doggie door? *

Yes No
Exercise and potty time for the pet will be (check all that apply) *

On lead or leash Tie-out or chain/trolley Fenced yard (totally enclosed) Partially fenced area Electronic/invisible fence Loose in yard Indoor potty area (peepads, litter box) Other
Do you have a pool, hot tub, spa, pond or fountain? *

Yes No
If so, please describe:
Pool type? *

Above ground In ground None
Is the area separately fenced?

Yes No
If not, how will the pet be protected from this area?
Is anyone in your home allergic to dogs? *

Yes No
Does anyone in your home fear dogs? *

Yes No
Does anyone in your home smoke? *

Yes No
Have you discussed this adoption with all members of your household? *

Yes No Yes, adults have discussed. Kids don't know yet.
Are you familiar with the Miniature Pinscher breed and the specific care that they require? *

Yes No
When will you be ready to adopt this dog? *

This weekend Within a week Within a month Not ready yet, just researching
Are you in contact with any other rescues or shelters about a specific dog? *

Yes, application is pending Yes, just an email inquiry, no app yet No, but I am looking at several dogs online No, 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 willing to deal with at the time of adoption or at any time during the life of the dog? *

Housebreaking Chewing Jumping Pulling on leash during walks Counter surfing Obedience training Fear of men Fear of women Fear of children Growling Barking Rough play with my dog High activity level Food/toy aggression/not willing to share with other dogs Food/toy aggression with people Whining/crying Blindness Limited Sight Separation Anxiety Diabetes Special Diet Long Term Medication Incontinence / Leaking Urine Gets stressed/carsick when riding in vehicle Can't climb stairs due to age/arthritis/health issues Heart condition Skin /Food allergies Trimming nails Monthly Heartworm preventative Annual heartworm/lyme combo testing I will do whatever it takes to help this dog adjust and work with a trainer to help resolve any training needs.
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? *

Yes No I 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 trims We trim dog nails ourselves at home We don't trim our dog's nails We bathe our dogs at home once a week We bathe our dogs at home once a month We bathe our dogs at home once every few months or whenever their coat feels dirty We don't bathe our dog We check ears weekly for infection/yeast/mites We clean teeth using home methods We 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? *

Yes No
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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