Adoption Application

**Due to the high volume of applications we receive, please allow up to 72 (business day) hours for a return call or email.  Also, Please be aware that we only receive puppies into rescue on average 1 to 2 times per year, so selecting “puppy” on your application could greatly extend your waiting period.  Incomplete applications will not be considered**

Please enter “N/A” if not applicable

Adoption Application

Name *

Full

Home Number

Cell Number *

Would you like to receive texts regarding your application (questions, status updates, etc.) on your cell phone? *

Yes

No

Work Number

Preferred Method of Contact (Daytime) *

Home Number

Cell Number

Work Number

Preferred Method of Contact (Evening) *

Home Number

Cell Number

Work Number

Email *

Email Updates

Check here to receive email updates

Address *

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe

Country

Age/DOB *

Are you applying for a specific dog? If so, which one? *

Are you applying for a male or female? *

Male

Female

No preference

Do you prefer cropped ears or uncropped ears? *

Cropped

UnCropped

No preference

Do you have a preference for a specific color? Which one? *

Black

Red

Blue

Fawn

No preference

Do you interested in adopting a puppy, adult, or senior doberman? *

Puppy

Adult

Senior

No preference

Would you consider adopting a doberman mix? *

Yes

No

Would you consider adopting a special needs dog (blind, deaf, etc.)? *

Yes

No

If the dog you adopted needed daily medication, what would your maximum monthly budget allow for? *

Example: $20/month, $50/Month, $200/Month, Etc

Would you consider adopting a dog that is missing a limb (like a leg, or eye)? *

Yes

No

Co-applicants First and Last Name(s): *

Co-applicant's age(s)? *

Number of children? *

Age(s) of children? *

Other resident's age(s)? *

Do the other residents of your home also want a doberman pinscher? *

Your occupation? *

Your employer's address? *

Your employer's phone number? *

555-555-555

How long have you worked for this employer? *

What are your current work hours? *

Are the other members of your household employed outside the home? *

What are their work hours? *

In what type of vehicle will the dog be transported (please specify make and model)? *

If you own a pickup truck, in what part will the dog be transported? *

Are you in the military? *

Yes

No

If you are in the military, what will you do with the dog when you are deployed? *

Do you plan to have any additions to your family in the next 5-10 years? *

If you move, what will you do with the dog? *

What kind of home do you live in (house, mobile home, apartment, etc.)? *

Do you rent or own your home? *

If you rent, do you have your landlord's permission to own a doberman pinscher? *

How large of a dog will your landlord allow? *

What is your landlord's name, and a phone number he/she can be reached at? *

How large in approximate sq feet is your home? *

Do you plan to keep the dog inside or outside? *

What type of fencing do you have for your yard? *

Privacy

Chain Link

Horse Fencing

Invisible

OtherOther

Height of fence, and size of fenced in area? *

How often do you plan on taking your dog on a leashed walk? *

Are your other pets off-leash trained without a fence? *

How many hours per day will your doberman be left alone? *

Where will your dog be during the day? *

Where will your dog be at night? *

Are you familiar with the use of a crate to train/confine your doberman when you're not home? *

Are you willing to use a crate? *

Is there any aspect of your home your dog could affect that would bother you (white carpet, antiques, etc.)? *

Are you willing to move breakable/spillable items out of your doberman's reach? *

Are you willing to submit to a home visit by a representative from APHDR? *

Yes

No

If asked, would you submit to a criminal background check (never to be made public)? *

Yes

No

Does anybody in your home have an allergy to pet hair? *

If you have other dogs, please list the breed, gender, and age of each: *

Are any of your other dogs dominant-aggressive? *

Are all of your other dogs spayed/neutered? *

Are you able to provide proof that your other dogs are all vaccinated and up to date on their shots (rabies,parvo/distemper, heartworm preventative)? *

If you currently do not own another dog, have you owned one in the past? What happened to him/her?

Please list any other pets you may have (cats, hamsters, birds, etc.): *

Have you ever taken an obedience class before? Are you willing to enroll your doberman in obedience classes if needed? *

Has anyone in your immediate family, or who is living with you, ever been convicted of, or charged with, cruelty to animals or domestic violence? *

Yes

No

Why do you want a doberman pinscher? *

Please list any dog behavior you find objectionable (chewing, digging, etc.): *

Do you currently have a veterinarian *

Yes

No

What is your veterinarian's name, address, and telephone number? *

Character Reference 1: Please list the full name and telephone number of a personal reference * *

Character Reference 2: Please list the full name and telephone number of a personal reference * *

Character Reference 3: Please list the full name and telephone number of a personal reference * *

If you are human, leave this field blank.