| Name: __________________________________________________________________________ Street ___________________________________________________________________________ Town/State/Zip __________________________________________________________________ Home Phone ( ______ ) _________________ Mobile Phone ( ______ ) _________________ Email address ___________________________________________________________________ When is the best time to call you? ________________________________________________ Occupation _____________________________________________________________________ Company _______________________________________________________________________ Work Phone (______)________________ Email address: ___________________________________________________________________ Do you own or rent your home? ___________________________________________________ Do you have an enclosed fenced yard? ___________________________________________ If you answered yes to having a fence, please describe the type of fence you have: _________________________________________________________________________________ _________________________________________________________________________________ If no fence, what arrangements will you have for the dog's exercise and toilet duties? _________________________________________________________________________________ _________________________________________________________________________________ Approximately, how many hours will your dog be alone each day? 3 or less 3-6 6-12 12-18 18-24 Would you be willing to have one of our representatives visit you in your home before adopting a dog from us? _______________ Will the dog be exposed to children on a regular basis? _______ If yes please answer the following: Age _________ Sex _________ Live With __________________ Visit ___________ Age _________ Sex _________ Live With __________________ Visit ___________ How many adults other than the primary owner will live in the house with the dog? _________________________________________________________________________________ Do you own other dogs? _________________________________________________________ If yes please answer the following: Name ___________________________________________________ Age _____ Sex _____ Neutered? _____ Breed ___________________________________________________________ How Obtained?__________________________________________________________________ Name ___________________________________________________ Age _____ Sex _____ Neutered? _____ Breed ___________________________________________________________ How Obtained?__________________________________________________________________ Name ___________________________________________________ Age _____ Sex _____ Neutered? _____ Breed ___________________________________________________________ How Obtained?__________________________________________________________________ Do you own any cats? ______________ How many? _______ If yes please answer the following: Age________ Sex_____ Neutered?_____ Indoor or Outdoor __________________________ Age________ Sex_____ Neutered?_____ Indoor or Outdoor __________________________ Have your cats lived with dogs before? ___________________________________________ Describe any other animals that you own: ______________________________________________________________________________ Is there someone home during the day? __________________________________________ Is there someone home at night? _________________________________________________ Where will the dog stay during the day? ___________________________________________ Where will the dog stay at night? _________________________________________________ Where will the dog sleep? _______________________________________________________ What other dogs have you owned in the past? Please give the dog's name and breed, the length of time you had the dog, and the reason why you no longer have the dog. _________________________________________________________________________________ _________________________________________________________________________________ Why would you like to own a Doberman? (if applicable) _________________________________________________________________________________ _________________________________________________________________________________ Have you ever obedience trained a dog before?__________________________________ Would you be willing to take obedience lessons with your dog?____________________ Please indicate how important the following qualities in a dog are to you. There are no right or wrong answers. The information will help find the right dog for you. Youth: _____ Very important _____ Somewhat important _____ Not important at all Maturity: _____ Very important _____ Somewhat important _____ Not important at all Well-trained: _____ Very important _____ Somewhat important _____ Not important at all Appearance: _____ Very important _____ Somewhat important _____ Not important at all Cleanliness: _____ Very important _____ Somewhat important _____ Not important at all Health/Physical fitness: _____ Very important _____ Somewhat important _____ Not important at all Affectionateness: _____ Very important _____ Somewhat important _____ Not important at all Protectiveness: _____ Very important _____ Somewhat important _____ Not important at all Independence: _____ Very important _____ Somewhat important _____ Not important at all Low maintenance: _____ Very important _____ Somewhat important _____ Not important at all Working ability: _____ Very important _____ Somewhat important _____ Not important at all Friendliness towards children: _____ Very important _____ Somewhat important _____ Not important at all Sociability with dogs other than dogs in household: _____ Very important _____ Somewhat important _____ Not important at all Sociability with people other than owner: _____ Very important _____ Somewhat important _____ Not important at all What attracted you to the Doberman? ____________________________________________ _________________________________________________________________________________ Please select the type of Doberman you are looking for: Watch dog _____ companion _____ hunter _____ obedience work/competition _____ For your needs, what are the three characteristics that you find most appealing about the Doberman? Choose three: Active shy playful calm independent intelligent loving dominant Aggressive submissive other__________________________________________________ Please provide the names and telephone numbers of at least two references that we may contact, please do NOT list relatives (neighbors, trainers, breeders, etc.). _________________________________________________________________________________ _________________________________________________________________________________ Current /most recent Veterinarian ________________________________________________ Veterinarian's Address ___________________________________________________________ _________________________________________________________________________________ Veterinarian's Phone (______)________________________ Where did you hear about this dog? ______________________________________________ Use this space to provide other important information. _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Please read the following statement: "I understand that owning a dog is a lifelong commitment and that I am willing to take on this commitment if I adopt a dog from Doris Ray. I certify that all the information I've provided in this online adoption application is accurate and true." If you accept this statement, please indicate so by circling "accept" / "decline. accept decline Thank you for your interest in adopting a rescue dog. __________________________________________ Date ______________________ Signature of Applicant *Adoption Donation for Dobermans is $200.00. Small breeds vary. Dogs receive all necessary veterinary care prior to adoption such as an examination, inoculations, heartworm test, deworming, neutering or spaying. Your contribution helps defray these and other costs incurred by our rescue dogs. Interview Date______________ rev 4/04 Return this signed application to: Doris Ray 205 Heron Drive Columbia, SC 29203 brokendobe@juno.com (803)754-1098 home (803)695-1698 work (803)422-3199 cell |