headergraphic

866.331.PINS



Contact Information

Name:

Street Address:

City:

State:     Zip Code:

County:

Home Phone Number with Area Code:

Work Phone Number with Area Code:

Cell Phone Number with Area Code:

How did you hear about SSMPR?
SSMPR WebSite I-800-Save-a-Pet PetFinder Search Engine
Other

Preferred Contact Number: Home Phone Work Phone Cell Phone

E-Mail Address:

Do you presently own a digital camera? YES NO

I am applying to:

YES    NO --- Foster Miniature Pinschers
YES    NO --- Assist with home checks for prospective adoptive homes
YES    NO --- Check my local shelter and report
YES    NO --- Screen owner surrenders and report
YES    NO --- Transport Miniature Pinschers
YES    NO --- Place spayed/neutered Miniature Pinschers with an approved contract
YES    NO --- Assist in other ways
If YES, list special skills and areas of interest (e.g. fundraising, public outreach):
Why do you want to  volunteer with SSMPR?

 

Household Information:

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

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

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

Where do you live:    House    Apartment    Other   

Does your home have a yard with a fence?    YES    NO
If YES,

  • What type fence:    Chain Link    Wood    Other   
  • How high is the fence?   

    Do you own your home:    YES    NO
    If NO,

  • Do you have permission from your landlord to keep a dog?    YES    NO
  • Would you agree to a home visit by an SSMPR representative?    YES    NO

    Fostering:

    Have you ever fostered a dog before?    YES    NO

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

    Where will you keep the dog while you are not home?

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

    Is there a limit to the length of time you can keep the dog until it gets adopted?    YES    NO

    If YES,

  • How long can you keep the dog?   
  • Why is there a limit?

    Is it OK if an interested person comes to your home to look at the dog?

    YES    NO

    Are you willing to assume financial responsibility for the every day care of the dog?

    YES    NO

    Are you willing to take the dog to a vet for spay/neuter, micro chipping, etc. (at SSMPR expense)

    YES    NO

    Home Placements:

    Are you willing/able to do preliminary home checks and post adoption checks for dogs placed in your area?

    YES    NO

    Are you willing/able to provide telephone support on training and behavioral issues for dogs you place?

    YES    NO Limitations

    If Limited, please describe:

    All paperwork for placement homes (e.g., applications, contracts) must be forwarded to the SSMPR Directors within five business days of completion. Are you able to ensure that this requirement is met?

    YES    NO

    Other Tasks to assist the dog owner or other SSMPR volunteers:

    Would you be able to take a dog to a vet for treatment, spay/neuter, micro chipping, etc. (at SSMPR expense)?

    YES    NO

    Would you be able to meet with an interested person at a dog's location (e.g. owner's home)?

    YES    NO

    Would you be able to have an interested person meet a dog at your home?

    YES    NO

    References:

    Please provide us with a veterinary reference (Including phone number):
    NOTE: Due to the new federal laws regarding the privacy act, you will need to contact your vet immediately and give permission for SSMPR to contact them regarding the status of your pets records.

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

    Additional Comments:

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

    Please do not submit this application if you are under 18 years of age.

    SSMPR thanks you for your application. Your application will be submitted to Denise, and you should receive word via e-mail within 48 hours.