CONTACT INFORMATION:

First Name*
Last Name*
Street Address*
Street Address (cont'd)
City*
State*
Zip Code*
Work Phone (including area code)
Home Phone (including area code)*
E-mail

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:*   
 

Dog’s AKC registered Name and Number (if known):

Gender:*   MALE   FEMALE

Spayed/Neutered?*   YES   NO   UNKNOWN
 

Date of Birth or Approximate Age:*  

Description (size, weight, etc.):* 

Color:* SALT & PEPPER     BLACK     BLACK & SILVER     OTHER ()

Ears:* CROPPED   NATURAL

Tail:* DOCKED   NATURAL

Breed:* PUREBRED SCHNAUZER     SCHNAUZER MIX (NON-SHEDDING)     SCHNAUZER MIX (SHEDDING)

Mixed with (if known)?  

Ever been bred (if known)?    YES   NO   UNKNOWN

If yes, 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? YES   NO   UNKNOWN

    crate trained? YES   NO   UNKNOWN

    leash trained? YES   NO   UNKNOWN

Does this dog …

    get along with other dogs? YES   NO   UNKNOWN

    get along with cats? YES   NO   UNKNOWN

    get along with children? YES   NO   UNKNOWN

    ride well in a car? YES   NO   UNKNOWN

Has this dog lived with children? YES   NO   UNKNOWN

    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   UNKNOWN

    If yes, to whom, and under what circumstances?

Is this dog possessive of toys, food, or his/her people? YES   NO   UNKNOWN

    If yes, please explain:

Has this dog lived with other animals? YES   NO   UNKNOWN

    If yes, what types?

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

Is he/she a house pet or an outside dog?  HOUSE PET     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? WALKS   KENNEL RUN   FENCED YARD   RUN LOOSE

Does your schnauzer walk on leash without pulling? YES   NO   SOMEWHAT

Walks best on?  HARNESS   COLLAR

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

At night, is this dog happiest in: YOUR BED   HIS/HER OWN BED (WHERE?) 

    HOUSE    CRATE    OUTSIDE    OTHER:

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

Has this dog been obedience trained? YES   NO   UNKNOWN

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   UNKNOWN

Is your schnauzer on heartworm preventative? YES   NO   UNKNOWN

        If yes, what type? 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.
 

 
 (sign here)*

Date:*  

If you would like to print a copy of your pet information form, please print it now. You will not be able to print this form after you submit it to NJSRN.

(This application prints best with the page orientation set to landscape.)

After you submit the form, you should be directed to a page that confirms submission of your pet information form. If you do not receive this confirmation, please e-mail the webmaster at webmaster@NJSRN.org.