New Jersey Schnauzer Rescue Network, Inc.
Finding permanent, loving homes
for Miniature Schnauzers and Schnauzer mixes
throughout the northeastern United States

PET INFORMATION FORM

In an effort to guide us in placing your dog in the best possible new home, please complete this questionnaire as completely and honestly as possible.

DATE:	
NAME:	
ADDRESS:	
PHONE NUMBER:	
E-MAIL ADDRESS:	

DONATION, if any (not required, but very much appreciated) $______________________ (Donations may be made on-line through our website at www.njsrn.org via PayPal. If you would prefer to mail a donation, please make your check payable to "NJSRN" and mail it to NJSRN, PO Box 36, Fanwood, NJ 07023.)

Dog’s name:	
Color:	
Description (size, weight, etc.):	
Ears:  CROPPED  or  NATURAL
Tail:  DOCKED  or  NATURAL
Dog’s AKC registered Name and Number (if known):	
Sex:  MALE  FEMALE
	Spayed/Neutered?	
	Date (if known)	
Date of birth or approximate age:	
Purebred or mixed (with what)?	
Ever been bred (if known)?	
	When?	
Most recent vaccinations (type, date):	

Dog originally obtained from:
	CASUAL BREEDER OR SHOW BREEDER (name, if known):	
	PET SHOP  SHELTER  FRIEND/RELATIVE  GIFT  STRAY
	OTHER:	
		on (approximate date):	
		at (approximate age):	

If dog was FOUND, please give location/date:	

Reason given up:	

Veterinarian/Clinic:	
	Address:	
	Phone Number (including area code):	

Is this dog …
	housetrained?	
	crate trained?	
	leash trained?	
 
Does this dog …
	get along with other dogs?	
	get along with cats?	
	get along with children?	
	ride well in a car?	

Has this dog lived with children?  YES  NO
	If yes, what ages?	

Does this dog have any known Medical or behavioral problems (please specify)?	

Has this dog ever bitten or shown any aggressive tendencies?  YES   NO
	If yes, to whom, and under what circumstances?	

Is this dog possessive of toys, food, or his people?  YES  NO
	Please explain:	

Has this dog lived with other animals?  YES  NO
	If yes, what types?	

Approximately how many hours/day is he/she alone?	

Is he/she a house pet or an outside dog?	

How frequently must he/she go out?	

How does he/she tell you he/she needs to go out?	

How do you exercise your schnauzer?     WALK     KENNEL RUN     FENCED YARD     RUN LOOSE

Does your schnauzer walk on leash without pulling?   YES   NO   SOMEWHAT
	Walks best on?  COLLAR   HARNESS

During the day, is this dog happiest in:  HOUSE   CRATE   OUTSIDE   OTHER:	

At night, is this dog happiest in:  YOUR BED   HIS OWN BED (where?)  HOUSE   CRATE   OUTSIDE   OTHER:	

Does this dog know how to go up and down stairs?  YES  NO

Has this dog been obedience trained?  YES  NO

Who had the major responsibility for training this dog?	

How does this dog respond to commands? EXCELLENT  GOOD  FAIR  POOR   WHEN HE/SHE WANTS TO

Please describe your schnauzer’s personality and temperament (hyper, couch potato, playful, affectionate, barker, etc.):	

What food do you feed your schnauzer?	
	Quantity and frequency:	

Does this dog need a dental cleaning?  YES   NO
 
Is your schnauzer on heartworm preventative?  YES   NO
	DAILY   MONTHLY
	Date last given:	

How long since his/her last grooming?	

Please describe, in your opinion, the type of home or the best home environment for this dog:	

Please obtain a copy of your schnauzer’s medical records, including spay/neuter certificate, Rabies certificate, and last DA2HPPv shot. A photo would also very much help us in placement.

The undersigned warrants that he/she is the owner or authorized agent for the owner and that the animal is in good physical condition; has no diseases or infections; is not vicious; and does not have a history of biting or attacking people. Any exceptions to these statements will be noted in the “Medical or behavioral problems” section above.

ALL STATEMENTS MADE ABOVE ARE TRUTHFUL TO THE BEST OF MY KNOWLEDGE.

Date	

Signature of owner or authorized agent:	

_____________________________________________________


Signature of NJSRN Representative:

____________________________________________________________


Please return completed form to surrender@njsrn.org.

Questions? Please call our rescue hotline at 908-534-2225

Revised 03/16/2007