UTAH DOBERMAN RESCUE ADOPTION APPLICATION

The answers you give on this application will help us to find the best possible match between you and the dogs available through Utah Doberman Rescue.
Please fill out the form completely. A phone number must be given and the application signed or it will be discarded.

 Name:__________________________________

Best time to call:_________E-mail address:____________________

 Home Phone:______________________Work Phone:_________________________

 Physical Address:______________________________________________________

 Mailing Address:_______________________________________________________

City:____________________________State:______________Zip:_______________

How long have you lived at this address:_____________________________________

If less than 1 yr., previous address:_________________________________________

City:____________________________State:______________Zip:_______________

Occupation:___________________________________________________________

Personal Reference - Name:______________________________________________

Phone Number:________________Relationship:_______________________________

Do you own or rent your home?____________________________________________

If rent, do you have landlord's permission to keep a dog?__________________________

Landlord's Name:___________________________Phone Number:________________

Do you live in a ( ) House ( ) Apartment ( ) Trailer ( ) Condominium ( ) Other:_________

Do you have a fenced yard?______If yes, height & type:__________________________

Does fencing completely enclose yard for dog?_________________________________

If no fence, how willl you handle dog's exercise & toilet duties?______________________
______________________________________________________________________

Do you have a separate kennel run?____List height & size:_________________________

How many adults in household?______________Children?________________________

Age and sex of children:___________________________________________________

Are there regular visitors to your home, human or animal, with which your new dog must get
along? Please describe:_________________________________________________

How many dogs have you owned in the last 5 years?______________________________

Give breed, sex and age of dogs you still own:___________________________________
___________________________________Spayed/Neutered?_____________________

If you do not still own dogs, what happened to them?__________________________________________________________________

Do you own cats_____How many?______Other animals?____________________________

Do you have a regular veterinarian?_______Name:_________________________________

Veterinarians's Address & Phone:______________________________________________

Have you owned a Doberman before?___________________________________________

Why did you choose this breed?________________________________________________

List all plans for this dog: ( ) Pet  ( ) Guard  ( ) Obedience  ( ) S & R  ( ) Therapy
( ) Other:________________________________________________________________

Do you prefer to adopt: ( ) Male ( ) Female ( ) No preference__

Color Preference:___________________Age Preference:____________________________

Size Preference:_____________________Ears: ( ) Cropped ( ) Natural__

I have marked my preferences above but would be willing to consider a suitable dog of a different:
( ) Color ( ) Age ( ) Size ( ) Sex ( ) Different Ears ( ) Long Tail__

Where will the dog spend the day?_____________________________________
( ) Loose Indoors ( ) Crate ( ) Basement ( ) Garage ( ) Fenced Yard
( ) Loose Outdoors ( ) Fenced Yard ( ) Tied Up Outside ( ) Kennel Run
( ) Other:_________________________________________________________________

How many hours, on average, will dog spend home alone?___________________________

Where will your dog spend the night?
( ) Loose Indoors ( ) Crate ( ) Basement ( ) Garage ( ) Fenced Yard
( ) Kennel Run ( ) Loose Outdoors ( ) Tied Up Outside
( ) Other:_________________________________________________________________

Do you agree to give this dog regular health care?________________

Do you agree to contact Utah Doberman Rescue if you can no longer keep this dog for any
reason?___________

Would you be willing to let a representative of Utah Doberman Rescue visit your home by
appointment?_______________If no, why?______________________________________

How did you hear about Utah Doberman Rescue?__________________________________

We do not charge for dogs placed in new homes. We do, however, ask that you make a
donation to Utah Doberman Rescue to help cover some of our expenses (such as shots,
spay/neuter, worming, etc.)__

All of the information I have given above is true and complete. Should an unneutered dog be
placed with me, I agree to have it neutered within one month of adoption, or by a date agreed
by me and a representative of Utah Doberman Rescue. This dog will reside in my home as a
pet. I will provide it with adequate food, water, shelter, training, affection and medical care.__

I understand that Utah Doberman Rescue is not responsible for the accuracy of information
received about the temperament, habits and physical condition 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. Utah Doberman Rescue, 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
I acknowledge that I have read and understand this paragraph.__

___________
Initials__

We reserve the right to refuse an applicant.__

Applicant Signature:__

_________________________________________Date:________________________

Please mail completed application to:

Utah Doberman Rescue
1584 E. Red Tree Court
Draper, UT 84020

For more info. please call Marsha Sheppard 801-553-6444

Please note: No rescue dogs are housed at the above address. Some are in foster homes and
some are cared for at boarding kennels.__