Internet Miniature Pinscher Service

Min Pin Adoption Application

** NOTE: Please answer all questions. An incomplete questionnaire will delay your application.
 

Name:
NOTE: Please include your last name - an incomplete questionnaire will delay your application.

Street Address:

City:

State:     Zip Code:

County:
NOTE: We only accept applications from Continental US and Canada.

Home Phone Number with Area Code:

Work Phone Number with Area Code:

Cell Phone Number with Area Code:

Preferred Contact Number: Home Phone Work Phone Cell Phone

E-Mail Address:

Do you presently own any pets?   YES    NO
If YES, list the name and kind for each pet (e.g. Ted - dog; Sai - cat; Skip - parrot):

If you own dog(s) are they all spayed/neutered?    YES    NO
If NO, why not:

Please provide us with a veterinary reference (Name and Address):

Vet's Phone Number with Area Code:

NOTE: Due to the new federal laws regarding the privacy act, you will need to contact your vet and give permission for IMPS to contact them regarding the status of your pets records.

Under what name are your vet records kept?
  As given at the top of this form
  Other:  

Have you owned pets in the past?   YES    NO
If YES, what kind of pet, and what happened to them.
Please also provide the name and phone for vet used, and the name under which vet records were kept:

Where do you live:    House    Apartment    Other   

Do you have a completely fenced yard?    YES    NO
If YES,
         -- What type fence:    Chain Link    Wood    Other   
         -- How high is the fence?   
If not fenced, how do you plan on exercising your minpin?

Do you own your home:    YES    NO
If NO,
         -- Do you have permission from your landlord to keep a dog?    YES    NO
         -- Deposit?           Weight Limit?    lbs.
         -- Name of landlord:           Phone:   

Do you have a crate to keep the dog in?    YES    NO

How many hours will the dog be alone during the day?   

Where will you keep the dog while you are at work or out on errands?

Where will you keep the dog while you are on vacation?

Why are you interested in adopting a Miniature Pinscher?

Do you have a preference for sex,color or age bracket?
(Please note that this is used as a guide only and there is no guarantee that IMPS can find you the dog of your preference - IMPS will still contact you if there is any rescue dog in your area)

How/where did you hear about IMPS?

How many adults presently living in the house?    Women:    Men:

Are there children presently living in the house?    YES    NO
If YES, What are their ages?   

Do you agree to an IMPS representative visiting your home to inspect prior to and after adoption?

YES    NO

Are you willing to enroll the dog in obedience classes?   

YES    NO

Do you understand that the Miniature Pinscher should never be allowed off lead in open spaces?

YES    NO

Please provide us with a personal reference (Including phone number):

Miniature Pinschers placed through IMPS are generally done so on the basis of proximity of the dog to the adoptive home. However, IMPS often transports dogs interstate. Please tell us if you are willing to:

  * Pay airfare costs to transport a dog interstate to you   YES    NO    
     (Approx. $200-250, subject to Airline and size/weight of dog)
   Please note this option is NOT available during the summer months due to airline regulations.

  * Drive interstate to pick up a dog   YES    NO
      If Yes, which states are you willing to drive to? 

Additional Comments:

** NOTE: Please answer all questions. An incomplete questionnaire will delay your application.
 

Please do not submit this application unless you are of legal age in your state.

IMPS thanks you for your application. Your application has been submitted to IMPS and you should hear from your IMPS Regional Coordinator shortly. Miniature Pinschers placed through IMPS are done so on the basis of proximity of the dog to the adoptive home and wait list position. You will be contacted regularly via e-mail to ensure that you wish to maintain your position on the waitlist.

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