Name:
Spouse's Name:
Other Adults in Household:
Address:
City, State, Zip Code:
Daytime Phone:
Evening Phone:
Best Time to Call:
E-mail Address:
Occupation:
Spouse’s Occupation:
Ages and Sexes of Children:
Does anyone in your household have allergies to animals?
	Yes No
How did you find out about our rescue program? If from the Internet, which website?
A representative from the rescue program will be contacting your veterinarian for a reference. Please call your veterinarian prior to our call to give permission for us to inquire about your past or current pet’s medical history.
	Veterinarian:
	Phone:
	Address:
	City, State, Zip Code:
List all types, and sexes (indicate if spayed or neutered) of other animals in household:
Have you ever owned a Doberman before?
	Yes No
If yes, tell us a little about the one you had or have.
If not, why did you choose this breed?
Sex Preference:			Male
			Female
			No Preference
Color Preference:			Black
			Red
			No Preference
Age Preference:
Would you be willing to consider a suitable dog of a different:
	Sex?	Yes No
	Color?	Yes No
	Age?	Yes No
Would you be willing to adopt a dog with uncropped ears?
	Yes No
Would you be willing to adopt a dog with an undocked tail?
	Yes No
List your plans/goals for this dog (Pet/Companion, Protection, Obedience Work, etc.):
Do you have a fenced yard or area for the dog?
	Yes No
If yes, list fence type, and height and size of fenced area
If no, what arrangements will you have for the dog’s exercise and elimination requirements
Where will the dog spend the day?
The night?
Do you understand and accept that all rescue dogs have to be spayed or neutered and that if you receive a dog that, for whatever reason, is not altered, that arrangements must be made with DPCCO Rescue to have the dog spayed or neutered as soon as possible?
	Yes No
Please describe the last dog you owned and what happened to it:
Would you be willing to let a representative of the rescue program visit your home by appointment?
	Yes No
Do you own or rent your home?
	Rent Own
If you rent, please provide us with your property management’s name and phone number:
In the event of a serious illness/injury or death and you were no longer able to keep the dog, is there a family member/friend who would be willing to assume responsibility for its care? If so, please provide name and telephone number.
Hand Me Down Dobes, Inc., reserves the right to follow up on the adoption in order to protect the welfare of the placed dog. If the terms and conditions of this agreement are not upheld by the adopter or if any misrepresentations have been made, Hand Me Down Dobes, Inc.reserves the right to terminate this agreement and the adopter must return the dog to the rescue program.
RELEASE OF LIABILITY
I understand that neither Hand Me Down Dobes, Inc., nor any of its representatives, is responsible for the accuracy of the information received about the temperament, habits, or physical condition of the dog available for adoption. I understand that it is my responsibility to see and evaluate the dog for myself before agreeing to adopt it. I am in full agreement with the terms of adoption. In redeeming a dog from the program, I accept full and complete responsibility for that actions of the dog in the event of an injury or death to myself or others and to indemnify and hold harmless Hand Me Down Dobes, Inc., including its representatives, agents, and board members for any such personal injury, death, or damage caused by such dog now or in the future.
Applicant Signature: Date:
After pressing "submit" you will be returned to the Adoption Procedures Page. Please allow 7-10 days for a representative to contact you to schedule a home visit. Please remember that our members are volunteers who work full-time jobs and commit to our program because of their love of the breed. Thank you!