Date
Last name:
First name:
Address:
City:
zip:
Home Phone:
Work Phone:
Mobile Phone:
Email Address:
Do you live in a House,Condo,or Apartment:?
Do you own/rent your home
If renting can you own a dog?
How many adults live in the home?
What are their ages?
How many Children live in the home?
If no children live in the home, do they come to visit?
What other dogs live with you,What Breed and age?
What other pets live with you?Cats?
Are your pets vaccinated?Spayed or Neutered
Are your pets dominant  or submissive?
Can you protect pets from new Doberman?
How much land,in square feet or acres do you have?
Do you have a fenced in yard?
Will dog be allowed outside of yard?
Do you have an invisible fence?
If yes,is the boundary flagged?
What kind of gate and latch is on your fence?
Can children open the gate?
Can the gate be locked?
Is the fence enclosed on all sides?
Is the fence in good repair?
If no fence,how do you intend to keep the dog confined to yard?
Can the dog climb over the fence?
Are there any distractions in the yard?
What is your work schedule?
If married does your spouse work?
What is His/Her schedule?
Do you travel frequently and if yes, where will
the dog stay?
Are there any loose dogs in the neighborhood?
Do your neighbors have dogs?
 Any mischievous children?
Can these problems be solved, and if so
explain how?
Do you own a pool or live near water?
Have you owned a Doberman before? If so,
What happened to it/them? Also please list
any other pets you have had and what
happened to them.
Are you ready to own a Doberman?
Please list all pros and cons
Will you be committed to a dog?
Is your lifestyle to busy?
Are you responsible?
Will you have children?
Will children or new baby get in the way?
Will children respect the dog?
Will baby get in way of dog?
 Will they treat the dog kindly?
Will they all be supervised?
Will children love the dog?
Are you aware dogs MAY NOT like certain people?
Can you accept this?
How will the dog be exercised?
Will obedience class be used?
What is expected of the dog?
What behavior is expected from the dog?
What kind of work is expected?
How will you handle mistakes?
How often will you train?
Is training necessary?
Is exercise necessary?
Is attention necessary?
Is companionship necessary?
Will the dog live in the house?
Where will the dog be kept?
What about when nobody is home?
Where will the dog sleep?
Are you aware of the costs involved?
Costs of vet care?
Costs of boarding?
Legal Responsibility is a must
I WILL take legal responsibility for the dog. Type yes or No
Can we inspect your home?
Do you want a male or female?
Ear preference (cropped or uncropped)
Tail preference?
Color preference?
Age range?
Where did you hear about Doberman
Pinscher Rescue and Referral ?
Will you provide a good home for the animals entire life?
Are you aware Dobes do not grow a winter coat and must have
a coat put on when let outside during the winter months ?
Name,Address and phone number of your veterinarian
Name,address and telephone number of reference #1
Name,address and telephone number of reference #2
Name,address and telephone number of reference #3
You have now completed the form. For your signature,Please type
your full legal name in the box below and click the submit button.