Adoption Application Please complete and return the form below Your answers on this application will help us find the best possible match between you and each of the dogs in our care. The more we know, the better we are able to make each adoption successful. 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?_________________________________________________________ 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 facilitate finding 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 to our non-profit organization 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