Name

Spouse/significant other:

Name

Children's ages:

Address:

Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country

Phone number:

Home Phone

E-mail address:

E-mail

May we call you collect, if long distance?:

yes
no

Occupation:

Occupation of spouse:

If this relationship were to change, who do you anticipate keeping the dog?

Are you planning to move in the near future?

Yes No

If yes, are you willing to give MsGPR the new address?

Yes No

Do all the adults in your household know that you want to adopt a dog?

Yes No

Is this Pyrenees going to be a gift?

Yes No

Are you familiar with the animal control regulations in your area?

Yes No

Who will be primarily responsible for the dogs care?

What is your basic weekly schedule?

Weekdays:

Evenings:

Weekends:

Where do you intend to keep the Pyrenees primarily?

indoors
outdoors

How many hours per day would the dog be left alone?

3 hours or less
more than 3 hours, but less than 6
more than 6 hours, but less than 12
more than 12 hours, but less than 18
more than 18 hours, but less than 24

Where will your dog spend the time left alone?

loose indoors
basement
garage
crate
kennel run
loose outdoors in fenced yard

Where will the dog sleep at night?

Type of dwelling:

house
condo
apartment

Do you rent or own your home?

rent
own

If you rent, do you have the landlord's consent to have a dog?

yes
no

If renting may we contact your landlord?

yes
no

Landlord's phone number:

Home Phone

How long at your address?

Would you allow an inspection of and post-adoption follow-up visit to your premises by an Mississippi Great Pyrenees Rescue volunteer?

Yes No

What other pets are kept and what are their ages?

Are they spayed and/or neutered?

Yes No

If not, why?

During the last two years have you....

lost a pet (not throught death)?
had one poisoned?
had an animal killed by a vehicle?
had an animal die due to disease?

If you lost an animal to disease, what did it die of?

What pets have you had in the past?

Do you still have them? If no, why not?

Have you ever owned a Great Pyrenees before?

Yes No

What other breeds have you considered adopting?

Have you applied to other RESCUE groups?

Yes No

If you have never owned a Pyrenees, have you done some research to learn about the breeds?

Yes No

What characteristics of a dog are most important to you?

For what purpose do want this Pyrenees?

What do you expect from a dog?

Generally speaking, what sort of temperament are you looking for in a dog? I.e., playful, quiet..

What brand of dog food will you feed or are currently feeding?

Is your yard or a portion of your yard solidly and securely fenced?

Yes No

Type of fence

Height of fence

Can children open the gates?

Yes No

What type of gates?

Can strangers gain access to your yard?

Yes No

If you have a doggy door, does it open into the fenced yard?

Yes No

Size of door:

small
medium
large
x-large

If you do not have access to a fenced area, please explain how you plan to exercise your dog and allow it to relieve itself.

Do you own a swimming pool?

Yes No

Is it secured?

Yes No

Will the dog have access ?

Yes No

Is your yard and home free of dangerous articles?

Yes No

Are you aware that many plants are known to be poisonous to pets?

Yes No

Have you checked your home and yard to assure your pets are restricted from such plants ?

Yes No

Are you aware that chocolate is toxic to dogs?

Yes No

Will you take necessary precautions to keep your dog from ingesting it?

Yes No

Are you aware that antifreeze is both toxic and enticing to dogs?

Yes No

Will you take necessary precautions to keep your dog from ingesting it?

Yes No

Are you aware that many breeds of dogs are high maintenance and require regular grooming to which includes removing hair from the ears, special eye care, brushing and/or cutting of the coat?

Yes No

Are you willing to provide that extra care?

Yes No

Are you aware that dogs need regular veterinarian care, especially as they age, which includes annual examinations, necessary vaccinations, worming when necessary, heartworm tests and heartworm preventative and other care as directed by your veterinarian?

Yes No

Are you willing to commit to this additional expense?

Yes No

Do you understand that the Pyrenees you adopt must be kept on monthly heartworm and flea preventative?

Yes No

On Heart Worm Preventative? Which product?

Use Monthly Flea Prevention? Which product?

Do you have a veterinarian?

Yes No

Veterinarian information:

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work Phone

Medical records under what name?

Will you be using the same vet your other animals are using?

Yes No

Are you aware that dogs might develop bad habits (destruction of clothing, furniture, drapery or anything within reach, biting, dislike of or fear of strangers or your mate, housetraining accidents) and that these habits can be difficult to break; that they may require a great deal of attention and maintenance and that they can be expensive to keep fed, healthy, housed and entertained?

Yes No

Do you fully understand and accept the fact that a Great Pyrenees must never be allowed off leash unless within a securely fenced area?

Yes No

Do you also understand that no amount of training can ever ensure that a Great Pyrenees can safely be off leash or unconfined, and that not strictly adhering to this restriction will place your dog at serious risk of injury, or even death?

Yes No

What precautions would you take to ensure your Great Pyrenees never gets lost?

What would you do if your dog(s) did get away or became lost?

What is your definition of disciplining a dog?

Do you understand that Pyrenees are known for being " barkers"?

Yes No

What housebreaking techniques do you or have you used?

If the dog develops a bad habit, what will you do?

Select any of the following options that apply: Under what circumstances would you not want to keep the dog?

Divorce/separation  Moving           Prefers one person over another   

New job             Barking          New relationship                             

Allergies           New baby         Serious illness                              

Doesn't get along with other pets      Biting          Other 

Preferences:

Male
Female
No preference

Age preference:

Under one year
1 to 2 years
2 years
2 to 4 years
Over 4 years
No preference

Would you consider an older Pyrenees?

Yes No

If yes, to what age?

Are you interested in a particular pyr from our website?

Yes No

If so, which one?

Are you willing to accept a dog with special medical needs?

Yes No

Are you willing to take a dog with a history of neglect or abuse that needs extra love and attention?

Yes No

Are you willing to accept a dog with behavior problems what require special training?

Yes No

Are you willing to housetrain a dog?

Yes No

Have you ever given a pet away?

Yes No

If so, what were the circumstances?

Have you ever taken a dog to a pound or shelter?

Yes No

If so, what were the circumstances?

How long are you willing to wait for a dog?

How will you transport a Pyrenees?

Car
Truck
Van
Other

How did you learn about Mississippi Great Pyrenees Pet Placement Program?

Yes No

 

I am in full agreement with the Mississippi Great Pyrenees Rescue Terms of Adoption. By submitting this form I am attesting to the truthfulness of my answers. I agree the adopted Pyrenees shall not be kept exclusively outside. I understand that falsification of any of the above information will be grounds to disallow the adoption of a rescue Pyrenees.

Thank you for taking the time to fill out this application. We realize there are a lot of questions, but the information helps us in making the right match for both our Rescues and Prospective Adopters. Thank you for your patience and for choosing to adopt a rescue dog! We will be in touch with you soon.

If you do not receive acknowledgement within 3 days, please email us. Thank you!

              REFERENCES:

Veterinarian.....

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone

Groomer....

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone

Non-relative Personal #1 (list at least two)

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work Phone

Non-relative Personal #2

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work Phone