Adoptive Parents Info
Primary Adoptive Parent
First Name* :
Last* :
Secondary Adoptive Parent
First Name:
Last:
Address* :
Maximum of 100 characters
City* :
State* :
Choose
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip* :
Home Phone* :
Cell Phone* :
Fax:
County * :
(not country)
Email* :
Employment Information - Primary Adoptive Parent
Occupation (primary): *
Employer: *
Address: *
City * :
State* :
Choose
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip* :
Employer Phone * :
How long at your present job * :
Employment Information - Secondary Adoptive Parent
Occupation (secondary):
Employer:
Address:
City:
State:
Choose
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
Employer Phone:
How long at your present job * :
Have you ever been charged with animal or child abuse? *
Yes
No
If Yes - When:
LIVING SITUATION:
Type of Residence *
House
Condo
Townhouse
Apartment
Mobile Home
Other
If 'Other' please list here:
Ownership *
Own
Rent
Other
If 'Other' please list here:
Are you planning to move in the near future? *
Yes
No
If 'Yes' please list location here:
May we visit your residence? *
Yes
No
Do You Have A Fenced Yard? *
Yes
No
Type of fence:
Height:
Approximate Dimension:
Attached to House?
Yes
No
If you Do Not Have a fence, how will the dog be exercised?
Are There Other Adults In The Residence *
Yes
No
If yes, enter the number:
Are there children in the home? *
Yes
No
If yes, enter their name, gender and age
PLEASE TELL US WHAT TYPE OF DOBERMAN YOU WOULD LIKE TO ADOPT:
Sex Preference *
Male
Female
Either
Color Preference: *
Black
Red
Blue
Fawn
White
No Preference
Ear Prefrence *
Cropped
Natural
No Preference
Age Preference * (check all that apply)
Under 6 Months
6 Months To 1 Year
1 Year To 3 Years
3 Years To 5 Years
Over 5 Years
No Preference
Did you see any specific Dobermans on the site that you were interested in adopting? *
Enter 'No' or if so please enter their name(s) in order of preference.
Why do you want a Doberman? *
What qualities do you most desire in a Doberman? *
(Quiet & Reserved ... Active ... For Agility Training)
Other Dogs / Animals
Have you or your spouse owned a Doberman before? *
Yes
No
If yes, How long ago?
If yes, what happened to it?
Are there other animals currently in the home? *
Yes
No
If yes, list type or breed, age, sex, neutered or not and where they were kept for each animal
What other animals have you owned in the past 5 years? *
Enter 'none' if you have not had other dogs. If you had dogs, what happened to them? What kind of problems did you have with them?
Have you ever given away, sold or surrendered a dog before and why? *
Yes
No
If yes, list the reasons below.
Do your neighbors have pets? *
Yes
No
If yes, please describe:
Are they aware that you will be adopting a Doberman? *
Yes
No
If yes, what was their reaction:
VETERINARY HISTORY:
List the veterinary clinic you currently use:
NOTE:
Please verify that you listed the correct address and phone number for your veterinarian's office. Please contact your vet office upon completing this application and give approval for DRT to verify your vet history. Not doing so could result in a delay in processing or your application not being processed. Incorrect information, or listing your personal phone number, will delay the application process.
Names of Pets Seen By Veterinarian *
List the Name & Breed - 1 per line
List other veterinarians that you have used in the past. *
Enter 'none' if you have not.
Please include Address and Phone Numbers
Pets Medical HISTORY:
Are your Pets current on all vaccinations, Rabies shots, heartworm and fecal tests? *
Yes
No
Do you vaccinate for Distemper/Parvo ?
Yes
No
Do you vaccinate for Bordatella?
Yes
No
Do you vaccinate for Rabies?
Yes
No
Do you test for heart worms?
Yes
No
Do you have fecal tests performed?
Yes
No
Are your pets current on heartworm preventative * ?
Yes
No
If yes, list the brand
OTHER INFORMATION
How long will dog be alone each day? *
How much time a day would be spent playing/training dog? *
Where will dog be housed during most of the day? *
Where will dog be housed during the night? *
Feelings about crate use and do you own one? *
Dog food to be fed * (please be specific)
Who will care for dog when you are out of town? *
List any Humane Societies, Organizations, Breed or Training Clubs you are Associated With *
Enter 'none' if not any.
Would you be willing to take the adopted dog to obedience classes? *
Yes
No
How would you handle a destructive dog? *
How would you handle a dog digging? *
How would you handle a dog chewing? *
How would you handle a dog that needs house training? *
How would you handle a dog that jumps on people? *
How did you hear about Doberman Rescue of the Triad? *
Are you currently registered with any other Doberman Rescues? *
Yes
No
If Yes, list please list the Agencies:
Additional Comments or Questions
Enter any addional comments or questions below you may have about this application.
Terms and Conditions
Doberman Rescue of the Triad reserves the right to refuse adoption of any Doberman in its program for any reason.
I AGREE THAT THE DOBERMAN I ADOPT FROM DRT WILL NOT BE USED FOR BREEDING PURPOSES, AND WILL BE ALTERED ACCORDING TO THE ADOPTION CONTRACT.
I AGREE THAT IF I CANNOT KEEP THE DOBERMAN FOR ANY REASON, I WILL RETURN IT TO DRT IMMEDIATELY, FORFEITING ANY ADOPTION FEE AND/OR DONATION GIVEN TO DRT.
DRT CANNOT HOLD DOGS INDEFINITELY. A DEPOSIT WILL BE REQUIRED, OR THE DOG WILL BE MADE AVAILABLE FOR THE NEXT ADOPTER. IF THE DOG IS NOT PICKED UP BY THE ADOPTER WITHIN THE AGREED-UPON-TIME, ADOPTER FORFEITS DEPOSIT AND ALL CLAIMS TO DOG.
I HAVE READ THIS ADOPTION APPLICATION IN ITS ENTIRETY AND HAVE UNDERSTOOD AND ANSWERED EACH QUESTION TO THE BEST OF MY ABILITY AND AGREE TO THE TERMS AND CONDITIONS.