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 *

City

State/Province

Zip/Postal

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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

Other

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 * *

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