Online Application for Adoption

Name(s):  

Street Address:  

City:   State:

Home Phone: Work Phone:

Cell Phone:

Occupation:

Name of Employer:

Spouse’s Occupation:

Name of Employer:

E-mail Address:  

ALL THE QUESTIONS BELOW REQUIRE A RESPONSE:

1.) Please list all pets that you currently own including sex and age.

2.) Are they spayed or neutered?      Choose... Unknown Yes No

If not, why not?

3.) Please list all pets that you have had in the last seven years. If you do not still have the pet, please tell us why.

4.) Why do you want a Doberman pinscher? Be specific.

5.) Have you educated yourself about this breed?      Choose... Yes No

6.) Please state your preference regarding the sex, age, and personality/behavior traits you would prefer.

7.) Would you consider something other than the stated preferences?      Choose... Maybe Yes No

8.) Would you consider a mix?      Choose... Maybe Yes No

9.) Would you be interested in being a foster home for Doberman Rescue?      Choose... Maybe Yes No

10.) List the names and ages of members of your household.

11.) If you do not own your home, do you have your landlord’s permission to keep dogs?      Choose... Unknown Yes No

12.) Can you provide documentation in writing?      Choose... Yes No

13.) How long have you lived at your current address?     Choose... 0-6 Months 7-12 Months 1-3 Years 4-6 Years 7+ Years

14.) Where will you keep your dog during the day, at night and during family absences overnight?

15.) Do you have a fenced yard?     Choose... Yes No If so, how large is the area, what kind of fencing, and how high?

16.) How will you exercise your dog, confine, and provide for its need to eliminate?

17.) What is the maximum and average number of hours that the dog will be left alone in a 24 hour period?

18.) Do you object to the discriminate use of a crate?     Choose... Yes No If so, why?

18A.) Do you have a crate?     Choose... Yes No If not, would you get one?     Choose... Yes No

19.) What will you do if your dog is destructive when left alone?

20.) Have you ever trained a dog before?     Choose... Yes No

If yes please specify

21.) Have you ever surrendered a pet of yours to an animal shelter?     Choose... Yes No

Have you ever sold or given away one of your pets?     Choose... Yes No If so, Why?

22.) Can you afford to spend at least $600 per year for food and routine medical care for your pet?     Choose... Yes No

23.) What do you plan to feed your dog? Please be specific.

24.) What are the requirements for dog ownership in your community including vaccinations, registration, and number of pets?

25.) Do you live in a covenant controlled community or belong to a homeowners association?     Choose... Yes No

26.) What circumstances, in your mind, would justify getting rid of a dog?

27.) Has anyone in your household ever been convicted of or charged with offenses relating to cruelty to animals or child abuse?     Choose... Yes No

Is there any such charge pending?     Choose... N/A Yes No If yes, please explain and give the disposition of charge. Use an additional sheet if necessary.

28.) Please provide the name, address, and phone number of your veterinarian.

29.) Please provide the name, address and phone number of your nearest living relative.

30.) Please provide the names, addresses, and phone numbers of two non-related individuals who can serve as references.

Reference #1

Reference #2

31.) May we visit your home and check your references to verify the information you have provided?     Choose... Yes No

Thank you for taking the time to complete this application. By typing your name below, you attest to the truthfulness of your answers. Falsification of any of the above information will be grounds to disallow your adoption of a rescued dog.

Applicant Signature: