PET INFORMATION FORM

In an effort to guide us in placing your dog in the best possible new home, please complete this form as completely and honestly as possible.

When you complete and submit your information, the form will be submitted to NJSRN automatically and shared with our members. One of our members will contact you shortly, usually within seven days, to arrange for surrender of your dog. Please e-mail at least two recent photos of your dog to info@njsrn.org. Please also contact your veterinarian's office to let them know you are surrendering your dog to NJSRN, and have them fax the dog's complete medical records to us at 855-416-5776 or e-mail them to us at info@njsrn.org. NJSRN ensures that all our rescued dogs are up-to-date on required vaccinations prior to adoption. We have limited resources, so the veterinary records will help us ensure that we spend our funds wisely. We will not refuse to accept a dog into our rescue program because it is not up-to-date on vaccinations, needs to be spayed or neutered, or has medical issues, but we appreciate any donation you can make to help off-set our costs.

If you must make arrangements to surrender your Miniature Schnauzer in the next few days, please contact our rescue hotline at 732-920-8242. If no one is available when you call, please leave your name, area code, and phone number. We will return your call as quickly as possible.

(Required fields are marked with an asterisk*.)

NJSRN is a non-profit 501(c)(3) charitable organization that relies on donations to help Miniature Schnauzers in need. Your donation will help us to offset the cost of caring for our rescued dog and allow us to continue this valuable work. Donations may be made on our website through PayPal or by check made payable to NJSRN. Checks may be given to the NJSRN member when you surrender your dog, or you can mail your donation to our official mailing address at PO Box 36, Fanwood NJ 07023.

E-mail Address: *
First Name: *
Last Name: *
Address 1: *
Address 2:
City: *
County (NOT "COUNTRY" (i.e., not "USA")): *
State: *
Zip Code: *
Phone Number (cell):
Phone Number (home): *
Phone Number (work):
Donation: *
Dog's Name: *
AKC Registered Name and Number (if known):
Breed: *
Mixed With (if known):
Gender: *
Date of Birth (if known) (mm/dd/yyyy):
Approximate Age: *
Approximate Weight: *
Color: *
Other Color:
Ear Type: *
Tail Type: *
Other distinctive markings or characteristics:
Spay/Neuter Status: *
Ever been bred (if known)? *
If yes, when?
Most recent vaccinations (enter date, if known (mm/dd/yyyy); otherwise, enter unknown).
Bordetella: *
Canine Influenza: *
Distemper Combo: *
Rabies: *
Most recent medical tests and treatments (enter date, if known (mm/dd/yyyy); otherwise, enter unknown).
4DX (heartworm disease, ehrlichiosis, Lyme disease, and anaplasmosis): *
Blood Panel: *
De-wormed: *
Flea Treatment: *
Urinalysis: *
X-rays: *
Most recent surgical procedures (enter date (mm/dd/yyyy), if known; otherwise, enter unknown).
Dental: *
Spay/Neuter: *
Is this dog microchipped? *
If yes, enter brand and number:
Where did you get this dog? *
Explain (include name of breeder, shelter, rescue group, or other, if known): *
... on (approximate date (mm/dd/yyyy)):
... at (approximate age):
If this dog was FOUND, please give location and date:
Reason for rehoming your Miniature Schnauzer: *
Do you have a timeframe in mind for surrendering your Schnauzer? *
Please explain when you would like to surrender your Schnauzer: *
Veterinarian First Name:
Veterinarian Last Name:
Clinic:
Address 1:
Address 2:
City:
State:
Zip Code:
Phone Number:
Are the records (vaccinations, tests, surgeries, check-ups, etc.) for this dog on file here?
Is this dog crate trained? *
Is this dog housetrained? *
Is this dog leash trained? *
Does this dog get along with other dogs? *
Does this dog get along with cats? *
Does this dog ride well in a car? *
Does this dog get along with children? *
Has this dog lived with children? *
If yes, what age(s)?
Does your Miniature Schnauzer have any known medical or behavioral problems? *
If yes, please specify:
Has this dog ever bitten or shown any aggressive behaviors? *
If yes, to whom and under what circumstances?
Is this dog possessive of toys, food, or his people? *
If yes, please explain:
Has this dog lived with other animals? *
If yes, what type(s)?
Approximately how many hours a day is your Miniature Schnauzer alone? *
Is this dog a house pet or an outside dog? *
How frequently must he go outside? *
How does he tell you he needs to go outside? *
How do you exercise your Miniature Schnauzer? *
Does this dog walk on a leash without pulling? *
Does he walk best on a ...? *
During the day, is this dog happiest in ...? *
At night, is this dog happiest in ...? *
Has this dog been obedience trained? *
Does this dog know how to go up and down stairs? *
Who had primary responsibility for training this dog?
How does this dog respond to commands? *
Please describe the personality and temperament of your Miniature Schnauzer: *
What food do you feed your Miniature Schnauzer (include brand name, flavor, and whether it is a dry food, canned, or in a pouch)? *
Quantity and frequency? *
Does this dog need a dental cleaning? *
Is this dog on heartworm preventative? *
If yes, what type?
Date last given (mm/dd/yyyy)?
How long since his last grooming? *
VERIFICATION: The undersigned warrants that he/she is the owner or authorized agent for the owner and that this dog is in good physical condition, has no diseases or infections, is not vicious, and does not have a history of biting or attacking people: *	Agree Disagree
Please describe, in your opinion, the best type of home or home environment for this dog: *
Any exceptions to these statements must be explained in response to the appropriate questions above (medical or behavioral problems, aggression, or possessiveness): *	Agree Disagree
ALL STATEMENTS MADE IN THIS SURRENDERED PET INFORMATION FORM ARE TRUTHFUL TO THE BEST OF MY KNOWLEDGE. Verification (read the statement above and type your name here): *
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