Adoption Application
  Personal Contact Information
Email:
Address:
Home Phone:
City:
State:
ZipCode:
County:
  Veterinary Reference
  Personal Reference
Vet / Clinic Name:
City:
State:
ZipCode:
Address:
Phone:
Phone:
City:
State:
Address:
ZipCode:
Name:
  Current and Previous Pets Information
MinPinHaven Adoption Application
Do you presently own any pets?
If yes, list names and kind of each pet, (ex. Star - Dog)
Yes
No
Are your pets spayed/neutered?
Yes
No
If no, why not? (Please explain below)
NOTE: The new federal laws protecting privacy require you to contact your vet and give them permission to speak with MinPinHaven Rescue regarding the status of your pet's records.
Under what name are your vet records kept?
Name:
Work or Cell:
Have you previously owned pets?
Yes
No
If yes, what kind and what happened to them (please explain)
Vet Name:
Phone:
Please provide name and phone for the vet used with the above pets.
  Home Enviornment Information
Yes
No
Height of Fence:
What Type of Fence:
Yes
No
Do you own your home?
Is your yard completely fenced?
Type of home:
Do you have a HOA?
Yes
No
If renting do you have permission from your landlord to have a dog?
Yes
No
What is your dog(s) per home limit?
Weight Limit?
Deposit Required?
Yes
No
Date Deposit Paid?
Landlord Name:
Phone:
Do you have a kennel for the dog?
Yes
No
How many hours each day will the dog be alone?
Where will the dog be when you are away from home?
Who will care for the dog when you are on vacation?
Do you have children?
Yes
No
Number and age(s) of children in the household?
  Dog Selection Information
Have you previously had a Miniature Pinscher?
Yes
No
If so, where is that dog today?
Are you interested in a particular dog? (please explain)
Do you have a preference as to sex or color of dog? (please explain)
Will you agree to a home visit by one of our volunteers?
Yes
No
Yes
No
Are you willing to enroll in obedience classes?
Do you understand that any miniature pinscher should never be allowed off leash other than in a completly fenced area?
Yes
No
Additional Comments?
  Please note; an incomplete application will delay the approval process
  Please do not submit an application unless you are at least 21 years of age
Format: 6025551212
Format: 6025551212
Format: 6025551212
Format: 6025551212
Format: 6025551212
Format: 6025551212
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