NJSRN Adoption Application (page 1 of 2)

Revised 12/12/2011

ADOPTION APPLICATION
(continued)

This is the second and final page of our adoption application.

If you forget to answer a required question, you will receive an error message. Please follow the instructions in the pop-up window.

(Required questions are marked with an asterisk.)

Contact information ...

E-mail Address: *

First Name: *

Last Name: *

Current pets ...

Do you currently have any pets? *

yes
no

Dogs: *

yes
no

If yes, list your current dogs, including their breed(s), sex(es), age(s), and spay/neuter status:

Please describe the personality(ies) of your current dog(s):

What do you feed your dog(s)? (Please include the brand name and whether the food is dry, canned, or a pouch.)

Are there situations in which you allow your current dog(s) off-leash?

yes
only occasionally (ex: from the car to the house)
no

Do you ever use a tie out with your current dog(s)?

yes
no

If yes, please describe the tie out and when and how it is used:

Cats: *

yes
no

List your current cats, including their sex(es), age(s), spay/neuter status, and whether or not they are declawed:

Other current pets (list):

Previous pets ...

Have you had pets previously? (Do not include your current pets.) *

yes
no

What kind?

dogs
cats
other

Not including any current pets, have you ever owned a Schnauzer? *

yes, as an adult
yes, we had a Schnauzer while I was growing up
no, I have never lived with a Schnauzer

If yes, how many and when?

What became of your previous Schnauzer(s)?

Have you ever owned another breed of dog?

yes
no

If yes, please list breed(s):

What became of your previous pets?

died
accident
gave away
other

For each of your previous pets, please tell us what happened and when. If they died, tell us how. If there was an accident, please tell us what happened. If you gave them away, please explain why. If something else happened, please explain.

Type of dog you are interested in adopting ...

Are you interested in adopting a specific dog from NJSRN? *

yes
no

If yes, what is the name of the dog?

What is it about this dog that interests you?

How familiar are you familiar with the temperament of a Schnauzer, its grooming requirements, etc.? *

extremely familiar
somewhat familiar
not very familiar, but I have been reading about the breed
what do you mean by a Schnauzer temperament ... they require grooming??

Are you adopting this dog for yourself or for someone else? *

for myself and my family
as a gift

If you are adopting for someone else, please explain:

Are ALL adult members of your household aware of and in agreement with this potential adoption? *

yes
no

If no, please explain:

Approximately how often would your dog be alone? (Please indicate which days and include the average number of hours.) *

Gender preference: *

female
male
no preference

Age preference: *

puppy (1 year or younger)
1 - 2 years
3 - 4 years
5 - 7 years
8 - 9 years
10+ years
no preference

Color preference: *

black
black & silver
salt & pepper
no preference

Ear preference: *

cropped
natural
no preference

Tail preference: *

docked
natural
no preference

Breed preference: *

purebred Schnauzer
Schnauzer mix (non-shedding)
Schnauzer mix (any)
no preference

Are you flexible on gender? *

yes
no

Are you flexible on age? *

yes
no

Are you flexible on color? *

yes
no

Are you flexible on ear type? *

yes
no

Are you flexible on tail type? *

yes
no

Are you flexible on breed? *

yes
no

What type of personality are you looking for (e.g., playful, active, quiet, cuddly, agile, mellow, etc.)? *

Do you have any special requirements (e.g., housetrained, good with kids/dogs/cats/existing pets, non-shedding, etc.)? *

Some of the dogs in our rescue program have special needs. Examples include:
- arthritis, prescription or special diet from the vet, medication-controlled minor illness (all minor needs)
- blindness, diabetes (requiring insulin), epilepsy, socialization/temperament issues (all major needs)

Would you consider adopting a special needs pet? *

yes, any special needs
yes, but only minor special needs
no, no special needs

Occasionally we take in pairs of Schnauzers. They may be siblings, parent and child, or bonded pairs. Our goal is to keep them together since that is what they have been used to.

Would you consider adopting two Schnauzers together, if they could not be placed separately? *

yes
no
maybe

Who will have primary responsibility for daily care or training? *

When you go on vacation, who will care for your dog? *

Where will your new dog spend most days? (Please be specific.) *

Where will your new dog spend most nights? (Please be specific.) *

Are there situations in which you will allow your rescued Schnauzer off-leash? *

yes
only occasionally (ex: from the car to the house)
no

If yes, please describe when and where:

Is there ever a time when you will tie your rescued Schnauzer outside? *

yes
no

If yes, what type of tie out would you use?

Do you plan to enroll your rescued Schnauzer in formal obedience training? *

yes
no

How do you plan to exercise your rescued Schnauzer? (Please be specific.) *

Do you agree to keep your adopted Schnauzer as a house pet/inside dog? *

yes
no

Briefly explain why you would like a Miniature Schnauzer: *

We do not operate a shelter. Our Schnauzers are housed temporarily in foster homes located throughout the region (primarily New Jersey, New York, and Pennsylvania). The Schnauzer that may be matched with your family could be several, or several hundred, miles from your home. Although NJSRN can usually help with some part(s) of the transportation, our policy dictates that a member or volunteer must be present to facilitate an adoption, and our closest volunteer may be located in a different state or a significant distance from you.

How far are you willing to drive (one way) to adopt a Miniature Schnauzer from NJSRN? *

I do not drive
up to 25 miles
25 - 50 miles
50 - 75 miles
any distance

References ...

Do you have a current or recent veterinarian? *

yes
no

If yes, may we contact him or her?

yes
no

Veterinarian First Name:

Veterinarian Last Name:

Clinic:

V1 Address1:

V1 Address2:

V1 City:

V1 State:

V1 Zip Code:

V1 Phone Number:

Are all records (vaccinations, tests, check-ups, etc.) for your pets on file here?

yes
no

Have you used an alternate or emergency veterinarian, clinic, or veterinary specialist?

yes
no

If yes, may we contact them?

yes
no

Veterinarian 2 First Name:

Veterinarian 2 Last Name:

Clinic 2:

V2 Address1:

V2 Address2:

V2 City:

V2 State:

V2 Zip Code:

V2 Phone Number:

Are the records (vaccinations, tests, check-ups, etc.) for your pets on file here?

yes
no

NJSRN requires at least three references, preferably at least one from your current or recent veterinarian. Please make sure that you have listed three references (groomer, pet-sitter, co-worker, friend, neighbor, etc. No relatives, roommates, or significant others, please.) and that all of their contact information is accurate and complete.

Reference 1 First Name: *

Reference 1 Last Name: *

Reference 1 Relationship: *

Reference 1 Phone Number: *

Reference 2 First Name: *

Reference 2 Last Name: *

Reference 2 Relationship: *

Reference 2 Phone Number: *

If you have not provided a veterinary reference, you must provide a third personal reference. No relatives, roommates, or significant others, please.

Reference 3 First Name:

Reference 3 Last Name:

Reference 3 Relationship:

Reference 3 Phone Number:

Other questions ...

Have you applied to any other rescue groups? *

yes
no

If yes, to which groups?

Are you financially prepared to provide care and upkeep for a dog at this time (at least $800+ per year)? *

yes
no

Have you ever been convicted of animal abuse or animal cruelty? *

yes
no

If yes, please explain fully:

Would you be interested in volunteering with NJSRN (foster home, transport volunteer, other)? *

yes
no
maybe - please contact me to discuss

If yes, what are you interested in doing?

How did you learn about NJSRN?

Questions/comments:

Acknowledgement, verification, and signature ...

I understand that completion of the adoption application is simply the first step in the adoption process. *

yes
no

I understand that an adoption donation of $50 - $750, determined by NJSRN and based upon the age and specific costs associated with each dog, is required at the time of adoption. *

yes
no

I affirm that I am at least 18 years old, that I have answered all of the above questions completely and truthfully and, to the best of my knowledge, the information I have provided is complete and accurate. *

yes
no

I give NJSRN permission to contact the references that I have provided. *

yes
no

Verification and signature (type your name here): *

* Required