Name
Spouse's Name
Street Address
City State AL AK AS AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Code
How long have you lived at this address?
Do you expect to move in the near future? Yes No
Home Phone Number
Work Phone Number
Best Time to Call
Email Address
Occupation
How long have you worked at your present job?
Spouse's Occupation
How long has your spouse worked at his/her present job?
Age, Sex, and Relationship of ALL Household Members, including youself:

Do you have children visiting regularly? If so, list ages.

Who will primarily be responsible for this dog?
Is this dog to be a gift? Yes No
Are all household members aware of your decision to acquire a Doberman? Yes No
Would you consider you/your household active or sedentary?
Does anyone in the household have allergies to animals? If so, explain the type of allergy.

How did you find out about our rescue program?

What other breeds have you considered?

Have you applied to any other rescue group? If yes, which ones?

Do you have a vet? Yes No
If not, would you like us to recommend one? Yes No

       A representative of SWODR will be contacting your current or most recent veterinarian for a reference. Please call your veterinarian prior to SWODR’s call to give permission for us to inquire about your past or current pet’s medical history.

Veterinarian
Phone Number
Street Address
City State AL AK AS AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Code
List other veterinarians that you have used. Include the address, phone number, pet's name, and how long ago.

Please give us the names and phone numbers of at least two references that we may contact (neighbors, trainers, breeders, etc. No family members, please.)

Please describe the last dog you owned, how long ago, and what happened to it.

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?

Have any family members ever owned a Doberman? Yes No
Why did you decide to adopt a rescue dog?

List all types, breeds, ages, and sexes of ALL animals currently in the household (indicate if spayed or neutered). Also, tell us how long you have owned each animal and where the animal is kept.

Are they current on heartworm preventative? If so, which one?
Have you ever given away, sold, or surrendered a pet before? If yes, give details.

Have you ever been charged with animal neglect or cruelty? If yes, give details.

What personality/behavior traits are you looking for in a Doberman?

What personality/behavior traits would not be acceptable?

Sex preference Female Male No Preference
Color preference Black Red Fawn Blue Albino No Preference

Age preference

Would you be willing to consider a 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

Do you want a dog right away or are you willing to wait for the "right dog" for you and your lifestyle?
List your plans and goals for this dog (pet/companion, protection, obedience work, agility, etc.).

Where will the dog sleep?

How many hours would your Doberman be alone each day?
Will the dog primarily be indoors or outdoors. Please explain.

Where will the dog spend:
The day:
The night:

If considering a puppy, will you be able to make arrangements for midday visits, since puppies need to go out every four hours or so to be housebroken? Yes No I am not considering a puppy
Are you willing to re-housetrain a dog, if necessary? Yes No
What would be your response if the dog had an "accident" in the house?

Who will care for your dog when you are out of town?
In the event of a serious illness or injury, is there a family member/friend who would be willing to assume responsibility for the care of the dog? If so, please provide name and phone number.

When walking my dog, I use a leash: Always Usually Sometimes
When and where was the last time you took an obedience or agility course?

SWODR strongly suggests that all dogs go through at least a basic Obedience Class. Do you intend to enroll your new dog in an obedience course? If no, please explain.

I would consider my level of experience with dogs as: Beginner Intermediate Advanced
How much time per day would be spent playing/training the dog?
Have you ever used a dog crate before? If yes, why?

Do you plan to crate-train this dog?

Do you own a dog crate? Yes No
What is your method of disciplining a dog?

Do you plan to exercise the dog? If yes, how?

Is the dog to be fenced in, tied out, or let loose?
Do you have a secure fenced yard or area for the dog? Yes No
If yes, please describe your fence:
Material:
Height:
Condition:
Relative Size:
Is there a door that directly leads from your home into the fenced area? Yes No
Are there locks on the gates? Yes No
Is the fenced area primarily: Grass Gravel Cement Other

Do you have a pool? If yes, is it fenced separately?

Do you have a balcony or deck? If yes, how is it secured so as the dog cannot fall over?

If you do not have a fence, what arrangements will you have for the dog’s exercise & elimination requirements?

If planning on leash-walking, how many times per day?
If you do not have a fenced area, would you be willing to install one? Yes No
What type/brand of dog food do you use?
How many times per day do you feed?

Please describe your neighborhood: Rural Suburb City
Please describe your home (house, apartment, condo, mobile home, other).

Do you own or rent your home? (If you rent, a copy of the lease will be requested before the adoption can be finalized.)
If you rent, please provide us with your property management’s name & phone number.

If you rent, what would you do if the property changed owners and no longer allowed pets?

Would you be willing to let a representative of SWODR visit your home? Yes No

Do you understand that this breed is a working/companion dog that requires exercise, training, attention, and human companionship? Yes No
Do you understand that it may take several weeks for a new dog to adjust to a new home/family? Yes No
Are you willing to be patient, work with the dog, and give the dog sufficient time to adjust? Yes No
If it seems the dog is not adapting easily or there are other issues, are you willing to seek professional help? Yes No
If you currently have other animals in the household, how do you plan to introduce the new dog to them?

Are you willing to take the good with the bad? (Hair on the furniture, "accidents" on the carpet, medical emergencies, behavioral problems, etc.) Explain, if needed.

Are you agreeable to returning the dog to SWODR should some unforeseen circumstance arise wherein you would no longer be able to keep or care for the dog? Yes No

Please give directions to your home. Use a major road/highway as a starting point.