Northern California Doberman Rescue
P. O. Box 8310
Red Bluff, CA 96080
530-529-5261
danjodobies@snowcrest.net 

The answers you give on this application will help us find the best
possible match between you and the dogs available through No. CA
Doberman Rescue.  Please fill out the form completely (keep scrolling
down to see all the questions).  A phone number must be given and if
snail mailed, a signature required.

Name: 

Address: 

City: 

State: 

Zip: 

Home Ph.: 

Cell Ph.: 

Work Ph.: 

E-Mail: 

Occupation: 

Personal Reference (Name): 

Relationship: 

Phone: 

Do you own your home: 

Do you rent your home: 

If renting, Landlord's Name: 

Landlord's Permission to have a dog: 

Phone: 

Do you live in a House: 
  Apartment: 
  Condo: 
  Mobile: 

How long at present address: 

Who carries your Homeowners Insurance: 

Do you have a fenced yard: 
  Height: 
  Type: 

Do you have a separate kennel run: 
  Ht: 
  Type: 

How many adults in the home: 

How many children in the home: 
  Boys: 
  Ages: 
  Girls: 
  Ages: 

Are there regular visitors with which your dog must get along: 
  Adults: 
  Children: 
  Dogs: 

Does everyone in the family want to adopt a Doberman: 

Current Pets
  Dogs: 
   Breed: 
   Age: 
   Male/Female: 
   Neutered/Spayed: 
  Cats: 
   How Many: 
   Indoor or Outdoor: 

Other Pets/Animals: 

How many dogs have you owned in the past five years that you no longer have: 

What happened to them: 

Do you have a regular veterinarian: 
  Name: 
  Ph.#: 

Have you owned a Doberman before:          
  How Many:            
  If not, why did you choose this breed:                                       
                                                                               

Looking to obtain:  
  Male:  
  Female:  
  Either:  

Coat Color Preference:  
  Black:  
  Red:  
  Blue:  
  Fawn:  

Age Preference:  
  Pup (up to 10 mo.):  
  Juvenile (11 mo. To 18 mo.):  
  Adult (1 yr. 7 yr.):  
  Senior (8 yr. up):  

Ear Preference:  
  Cropped:  
  Natural:  
  Doesn't matter:  

Plans for this dog:  
  Pet:  
  Guard:  
  Search & Rescue:  
  Therapy Work:  
  CGC:  
  Obedience/Agility Competition:  
  Other:  

Where will the dog spend the daytime hours:  
  Indoor/Outdoor:  
  Loose in House:  
  Confined to one room:  
  Crate:  
  Garage:  
  Yard:  
  Kennel Run:  
  Chain:  

Where will the dog sleep:  
  Crate:  
  Loose indoors:  
  Laundry room:  
  On your bed:  
  Outside:  
  Garage:  
  Wherever he/she wants:  

If you will be away on vacation, who will look after the dog:  
  Neighbor:  
  Family:  
  Boarding Kennel:  
  Vet Office:  
  Other:  

How will you transport your dog:  
  Loose in Car:  
  Crate in Car:  
  Seat Belt:  
  Open Truck Bed:  
  Truck w/Camper Shell:  
  Other:  

How many hours on average will your dog be alone:  

If you move where dogs are not allowed, what will you do with your dog:
                                                                     

Have you ever attended obedience classes with a dog:  

Are you willing to attend proper obedience classes with your dog
(this is not a requirement for all dogs adopted but may be required
with individual dogs.  Classes help cement the bond between dog and
owner):  

A fee is charged for each dog to help defray medical and care expenses.

All of the information I have given above is true and complete.  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 Northern California Doberman Rescue is not responsible for
the accuracy of information received about the temperament, habits, or physical
condition of dogs available for placement.  I understand that it is my
responsibility to see and evaluate the dog for myself before agreeing to
accept it.  I am in full agreement with these terms of placement.  Northern
California Doberman Rescue, and any person associated with its placement
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 a placement contract to place a dog in my
home.  By my initials I acknowledge that I have read and understand this
paragraph.   _________ (initials)



_____________________________________________________________________
Applicant's Signature
Date:  

Thank you for filling out the above application!