Doberman Rescue of New Mexico

What is the name of the dog you wish to adopt?

Name
Email Address
Physical Address
City, State, Zip
Cell Phone
Home Phone

Company where you work
Occupation
Company Address
Company City, State, Zip
Company Phone

Marital Status
Do you have roommates?
How many adults live in your household?
What are their ages, including yourself?
How many children live in your household?
What are their ages?

What type of home do you live in?	If other, please explain:
How long have you lived in your current home?
Do you own or rent?
If you rent, do you have the landlord's permission to keep a dog?
If you rent, what is your Landlord's Name, Address, and Phone Number?	Name: Address: Phone:
If you move to a home where dogs are not allowed, what would you do with the dog?
Do you have a completely fenced yard suitable for a dog?
Do you have a kennel run?
Please describe the fence/kennel area: (Type, Height, Approx. Size)
If you do not have a fence, how will the dog be exercised?
When you are at home, where will the dog be kept?
Where would the dog sleep?
How many hours per day will the Doberman be left alone and where will it be housed while you are gone?
Whose responsibility will be the care of the Doberman?

Have you ever owned a Doberman before?
What pets do you currently own?

	Type (Dog, Cat, etc.)	Breed:	Age:	Sex:	Spayed/Neutered:
Pet 1:
Pet 2:
Pet 3:
Pet 4:
Pet 5:

Other than these pets listed above, how many pets have you owned in the last five years?
If you do not still own them, what happened to them?
Have you ever given away any of your pets?
If yes, why?

Do you have a regular Veterinarian?
Please provide the Veterinarian/Clinic Name, Address, and Phone Number	Vet/Clinic Name: Address: Phone:
Are you prepared to give the dog any needed health care?

Please describe visitors/family that come to your home, human or animal, with which the dog will have to interact with:
Describe your lifestyle:	Active Passive
Will you attend dog obedience classes?
What activities do you plan on doing with your dog? (Check all that applies)	Pet/Companion Agility Guard Therapy Obedience Other: Please explain:
What behavior would cause you to return the dog to Doberman Rescue?

Personal Preferences:
Do you have an age preference?
Do you have a gender preference?
Do you have a color preference?
Would you consider a dog with natural ears?
Would you accept a dog with a natural tail (not docked)?
Would you be willing to have DRNM representative visit your home prior to and at lease once after the adoption?

References:
Please provide 3 personal references of people that do not live in your household

	Name	Phone Number	Relationship to You
Reference 1:
Reference 2:
Reference 3:


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Do you have any additional comments or information you feel is important to tell us?

The information on this questionnaire will be kept confidential. Please read the paragraph below carefully.

I understand that Doberman Rescue of New Mexico (DRNM) is not responsible for the accuracy of information received about the temperament, habits and physical conditions of dogs available for adoption. I understand that it is my responsibility to see and evaluate the dog for myself before agreeing to adopt it. DRNM, and any person associated with its adoption efforts, is in no way liable or responsible for any damage, accident or injury resulting from the placement of a dog into my household. I also understand that I will be required to sign an adoption contract to place a dog in my home. I am in full agreement with these terms of adoption.

By my initials, and by selecting to submit this form, I acknowledge that I have read and understand this paragraph.

Initial Here:

To validate human entry on this form, please answer the following question:

Is the object below a dog, a cat, or a bird?