Black Horse Miniature Schnauzer Rescue


Adoption Application

The answers you give on this application will help us to find the best possible match between you and the dogs available through BHMSR. Please fill out the form completely and return with $5.00 processing fee to the address at the end.

If no phone number is given, this application will be discarded.



Name:________________________________________________________________________ home phone (___)__________________
Address:______________________________________________________________________ alternate phone (___)_______________
City:__________________________ State:______ Zip:___________ Email:_______________________________________________
Best time to call: (am / pm)_______________________________________________ Occupation:________________________
Personal reference: Name:________________________________________________________phone (___)_______________________
Relationship: ___________________________________________________________How long known?___________________
Do you own or rent your home? ________________If you rent, do you have the landlord's permission to get a dog?_________
Landlord's name and Phone number: _______________________________________________________________________
Do you live in a (circle): house * apartment * trailer * condo * other_______________________________________
How long have you lived at this address?_______________ How many times have you moved in the last 5 years?_______________
Why?__________________________________________________________________________________________________
Do you have a fenced yard? ___________ Fence height and type:___________________________________________________
Does fencing completely enclose a yard for the dog?__________________________________________________________
If no fence, how will you handle dog's toilet and exercise requirements?_____________________________________________________
Do you have a separate kennel run? ___________________Height and size: ___________________________________
How many adults in household? __________________ How many children? ___________________________________
Ages and sex of children:____________________________________________________________________________
Are there regular visitors to your home, human or animal, with which your new dog must get along?____________________
Describe:_____________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Do you own other dogs?____________________ Are they neutered? __________________________________
Give breed, age and sex of each:_______________________________________________________________________
_______________________________________________________________________________________________________________
Do you own cats? __________How many?________ Any other animals you own?_________________________________________
Do you have a regular veterinarian? _________Name: __________________________________________________________________
City and phone number: ___________________________________________________________________________________________
How many dogs have you owned in the last 5 years? _________ Still own any of these? ________________ If not, what happened to dog?
(Be specific) ________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Have you owned a miniature Schnauzer before? ___________ Why did you choose this breed?_____________________________
_______________________________________________________________________________________________________________
List all plans for this dog (circle): pet * watch/guard * hunting * obedience * agility * other_____________________
Do you want to adopt a (circle): male * female * no preference Why? ____________________________________________
Color preference (circle): Salt&Pepper * Black&Silver * Black * no preference Acceptable age range: __________
I have marked my preferences above but I am willing to consider a suitable dog of a different (circle): sex * color * age
Where will the dog spend the day? (circle) loose indoors * crate * basement * garage * fenced yard * loose outdoors
* tied up outside * kennel run * other _____________________________________________________________________________
How many hours a day, on average, will the dog spend alone? __________________________________________________
Where will the dog spend the night? (circle) loose indoors * crate * basement * garage * fenced yard * loose outdoors
* tied up outside * kennel run * other _____________________________________________________________________________
Are any family members allergic to dogs?_______ Describe:____________________________________________________
If yes, has family physician ok'd getting a dog? _____________ Do all family members want to get a dog?_____ If no, describe:
__________________________________________________________________________________________________________
Do you understand BHMSR requires all adopted dogs to be spayed/neutered? ______ Do you agree to comply? __________
Do you agree to license an adopted dog and give regular health care? _____________________________________
Do you agree to contact BHMSR if you can no longer keep this dog? _______________________________________
Would you be willing to let a BHMSR representative visit your home by appointment?___________ If no, why not?
_______________________________________________________________________________________________________________
How did you hear about BHMSR? __________________________________________




All of the information I have given above is true and complete. I have also read and agree with BHMSR's Terms of Adoption. Should an unneutered/unspayed dog be placed with me, I agree to have it neutered within one month of adoption or by a date agreed upon by me and a representative of BHMSR. This dog will reside in my home as a pet. I will provide it with adequate food, water, shelter, training, affection, and medical care. I understand that while BHMSR will provide me with as much information about the dog I adopt, it is impossible to know everything about these dogs due sometimes limited intake information and is therefore not responsible for the accuracy of the information about the temperament, habits or physical condition of dogs available for adoption. I understand that it is my responsibility to see and evaluate the dog for myself before agreeing to adopt it. I am in full agreement with these terms of adoption. Black Horse Miniature Schnauzer Rescue is in no way liable or responsible for any damage, accident or injury resulting from the placement of a dog into my household.




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Applicant


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Co-Applicant


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Date

An adoption donation of $50-$250 will be asked if a dog is placed with you through Black Horse Miniature Schnauzer Rescue. This is necessary in order to continue our work.

We reserve the right to refuse any applicant.



Thank you for contacting the BHMSR. Our adoption Coordinator should be contacting you shortly after receiving your paperwork. If you have not received a response (by phone or mail) in ten working days, call BHMSR at (360) 392-0008. In most cases you will be contacted before this call becomes necessary but some times our volunteers handle a great deal of paperwork. This way we can be sure your gets the prompt attention it deserves.

Please mail this form and $5.00, nonrefundable, for processing to:

Chris Davis

8029 Kendall RD, Maple Falls, WA 98266




BHMSR Mission: BHMSR is a privately run organization dedicated to placing unwanted, abandoned, rescued Miniature Schnauzers into suitable homes and preventing unwanted Miniature Schnauzers form overloading the shelter system. Towards attaining those goals, we promote responsible dog ownership by educating the public in the selection, care and training of dogs. Founded as a non-political organization, BHMSR works cooperatively with the breeders, animal shelters, breed clubs and individuals to accomplish BHMSR's purpose.




























Terms of Adoption

The following agreement specifies what we feel is required to provide a safe and loving home for a dog. Please understand that the details of the contract reflect our concern that both the owner and dog have a happy life together. The conditions set forth are based on years of experience and a continuing commitment to see that our rescue dogs enjoy safe and happy permanent homes. We hope that you will understand that considerable emotional involvement, time and energy go into ensuring that our rescue dogs have the best possible second chance at life.

If I am successful in the adoption of a dog through Black Horse Miniature Schnauzer Rescue I agree to the following conditions.

1. To keep this dog in my personal possession, and to provide proper and sufficient food, water, shelter, grooming and humane treatment at all times.

2. To spay or neuter this dog within 30 days of adoption at my expense if dog is not already altered. Proof of spaying or neutering will be provided in writing to BHMSR within ten days of surgery. I will not allow this dog to breed or be bred under any circumstances.

3. To procure veterinary care at once if this dog becomes sick or injured, and to keep current all vaccinations as recommended by my dog's veterinarian.

4. To provide this dog with an ID tag secured to a buckle collar which will be worn at all times.

5. To obey all animal control regulations governing the area in which I live, and to liscense this dog according to such regulations within one month of adoption.

6. Not to sell, trade, transfer ownership, abandon or dispose of this dog in any way, but to notify BHMSR if I must relinquish custody of the dog. This includes release to family members.

7. To allow a BHMSR representative to examine the dog and its living conditions, and to surrender it to said representative for return to the organization if the conditions are found unsatisfactory.

8. To assume full responsibility for this dog's actions, including any damage done by this dog.

9. To keep this dog as my household pet and companion. To ensure that when outside and unattended, the dog is in a secure fenced yard or kennel run with adequate shelter from the elements. To exercise him or her on a leash or within a fenced yard or kennel run, and never to allow the dog to run loose without adequate adult supervision. To never chain or tie this dog without being in attendance.

10. To never allow this dog to be transported in the open bed of a pickup truck or similar vehicle without being properly secured (in accordance with Washington State law).

I hereby agree to abide by the Terms of Adoption listed above.

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Signature


__________________
Date


Your signature on your Adoption Application indicates that you agree to the above Terms of Adoption. Keep your copy of this form carefully filed for your records.