Fill and Sign the Bir Form 2551m Sample

MapleCreek Miniature Schnauzer Rescue Roz Shroyer Woodland, WA 360-225-8654 Roz@MapleCreekMSR.org http://www.MapleCreekMSR.org Adoption Application In an effort to guide us in identifying a compatible rescue dog for you to adopt, please complete this questionnaire as completely and honestly as possible. Date: Name: Address: City: State: Home Phone: Best time to call: Work Phone: Cell Phone: Are you married or living with another adult? Zip: E-mail: yes no If yes, does your partner approve of you adopting a dog? yes no Ages of children in the home: Do you plan to have any more children? yes How often do children visit? Do you work outside the home? no Ages of visiting children: yes no If yes, occupation: What type of dwelling do you live in? own If renting, do you have your landlord’s permission to have a dog? Landlord’s name: Phone: Are you interested in a male or female? Why? yes rent no What age range would you accept? Do you intend to keep this dog primarily indoors or outdoors? indoors outdoors Where will the dog stay while you are gone? Where will the dog sleep at night? Do you have a secure, fenced-in area for the dog? yes no What kind of fencing? Please list all your current pets and their breed, age, gender, spayed/neutered: Please list any previous dogs you have owned as an adult. Explain if the dog died or why you no longer have the dog, including dogs you may have lost, surrendered to a shelter/rescue, or given away, and why: Are you prepared to assume the financial responsibilities of caring for an animal, including inoculations, regular grooming, veterinary care, good quality food, licensing, etc? MapleCreek Miniature Schnauzer Rescue: Adoption Application yes no February 2009 Adoption Application 2 What type of food do you plan to feed the dog? Who will be responsible for feeding the dog? Is this Miniature Schnauzer going to be a gift? Do they know they are getting the gift? yes yes no For whom? no Do you understand that any rescue dog you may adopt through MapleCreek Miniature Schnauzer Rescue will be spayed/neutered? yes no Do you agree to allow an agent of MapleCreek MSR to visit your home by appointment? yes no Please provide your vet's contact info: Name: Phone: Address: Please give a brief description of your lifestyle and hobbies: Please provide any other information you feel would be helpful: Two personal references are required from sources such as a friend, neighbor, coworker, groomer or pet sitter (no relatives): Name 1: Relationship: Address: Name 2: Phone: E-mail: Relationship: Address: Phone: E-mail: If no veterinary reference was given, please provide a third personal reference: Name 3: Address: Relationship: Phone: E-mail: By submitting this application, I affirm that I have answered all of the above questions truthfully and that the above information is correct. I give my permission to contact the above references. * * * Adoption Application is subject to approval by MapleCreek Miniature Schnauzer Rescue * * * MapleCreek Miniature Schnauzer Rescue: Adoption Application February 2009