First & Last Name *

Address *

City *

State *

Zip Code *

Cell Phone *

Home Phone

Other Phone

Name of Veterinary Clinic *

Veterinarian Phone Number *

What is the name on your Veterinary Record? *

Do we have permission to contact your vet? *

Do you OWN or RENT your home? *

What type of home do you live in? *

If renting, do you have your landlord's permission to have a dog?

What is your Landlord's name and phone number? (MUST PROVIDE IF RENTING)

Do you have a fenced yard? *

How high is your fence?

What material is the fence made of?

If you do not have a fenced in yard, what arrangements will you make to attend to the dogs exercise and toilet needs?

How many hours per day will the dog be left alone (without a human)? *

Where will the dog stay during the day? *

Where will the dog sleep at night? *

Please tell us about the dogs you have had in the past 10 years (gender, breed, age, spayed/neutered). Do you still own these dogs? If not, what happened to them?

Do you have any other pets other than dogs? (cats, birds, reptiles, livestock, etc) If so, what type?

Do you have any children? If so, please tell us how many and their ages.

Will any children be visiting this dog? *

Please tell us about the Doberman you would like to adopt: *

Color Preference *

Ears *

Tail *

Are there any dogs on our site you are particularly interested in? *

Please describe your "ideal" dog: *

How did you hear about us?