Schnauzer Rescue Cincinnati

  Adoption Application

  Instructions: Please fill-out all questions, if they do not apply to you put "N/A".
   
Dog Request information  
   
Did you see this dog on Petfinder?  Yes No
Did you see this dog on Adopt-A-Pet?  Yes No
If not above, where?
   
   
Name of dog interested in?
Gender Preference?  Male Female
Age Preference?
Color Preference?
Undesirable traits?
   
Your Information  
   
Applicant's Name:
Address:
City, State:
Zip:
Home Phone:
Call at work?  Yes No
Work Phone:
Mobile Phone:
Email Address:
Occupation:
Do you work outside the home?  Yes No
Hours away from home?
Applicant's Age:
   
Your Family  
   
Married or Significant Other  Yes No
Spouse or Other agree to Adoption  Yes No
Children?  Yes No
How many Children?
Ages of Children?
Children Visit?  Yes No
Plan to have Children?  Yes No
Others living in Household?  Yes No
  If "Yes" Age, Relationship, etc.
 
   
Your Home  
   
Dwelling Status:   
Type of Home?
Landlord Permission for pets?  Yes No
  Landlord Name and Phone Number?
 
   
Is there a Fence Yard?  Yes No
  Type of Fence?
 
  Fence height?
 
   
Have a Pool?  Yes No
Pool Fenced?  Yes No
   
Pet Care  
   
  Will the dog be kept on leash if not in fenced area?
   Yes No
   
  If no, explain how often dog would be off leash.
 
   
  How do you handle retraining?
 
   
  Hours dog will be home alone?
 
   
  Where is the dog when you are not home?
 
   
  Where is the dog when you are home?
 
  Allowed on furniture?
   Yes No
   
  Hours spent with your dog?
 
   
  Vet Reference? (Please include Vet Name, Clinic Name, Phone Number, Pet Name)
 
   
  If you do not currently have, or have never had a vet, please provide THREE (3) References
NOT RELATED TO YOU: (Include Name, Phone, Relationship)
 
   
  Adequate Funds for Medical Expenses?
   Yes No
   
  How will you handle chronic illness?
 
   
  Other pets owned, and are they altered?
 
  Are your pet's current on all vaccinations?
   Yes No
  Are your pets on Heartworm Preventative?
   Yes No
  Are your pets on Flea Treatment?
   Yes No
  Have you ever given away, sold, surrendered, euthanized or "gotten rid" of a pet?
   Yes No
  If Yes, Explain:
 
   
  Arrangements for pets when out of town?
 
   
  Why you are interested in a Rescue Dog?
 
   
  Additional comments you would like to make to help us better evaluate your application for adoption?
 
   
  PLEASE READ

Schnauzer Rescue Cincinnati will attempt to provide you with an honest evaluation of temperament and medical history known to us on any dog we have looking for a home.

Do you understand, that often times the complete history of a rescue dog may NOT be known, and you may encounter some behavioral and / or medical problems not previously known to us?

I have read and understand the above statements.  Yes No

   
 
   After submitting the form you should see a "thank you" screen. If you do not see this, the submission has failed. Please re-submit a new form.