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Blue Ridge Doberman Rescue
PO Box 232254
Centreville, VA 20120-8254
blueridgedobermanrescue@yahoo.com
ADOPTION APPLICATION
Name:___________________________________________________ Date:_______________________________
Spouse’s Name: _______________________________________________________________________________
Home Address:_________________________________________________________________________________
Phone: __________________________________ (home) _________________________________________(work)
Best time to contact you: ___________________________ e-mail:_______________________________________
Occupation: ___________________________ Employer: ______________________________________________
Spouse’s Occupation: ___________________________ Employer: _______________________________________
How many adults in household? _______________ Children (gender and ages): ________________________________
Other Pets in Household (use other side if additional space is needed):
Type of Pet Age Years Owned Last Vaccinated Spayed/Neutered Heartworm Preventative
___________ _____ ___________ _____________ ______________ _____________________
___________ _____ ___________ _____________ ______________ _____________________
___________ _____ ___________ _____________ ______________ _____________________
___________ _____ ___________ _____________ ______________ _____________________
Previous Pets:
Type of Pet Age Years Owned Spayed/Neutered What Happened to them?
___________ _____ ___________ _____________ ______________________________________
___________ _____ ___________ _____________ ______________________________________
___________ _____ ___________ _____________ ______________________________________
___________ _____ ___________ _____________ ______________________________________
How long at current address:__________ Home/Apartment/Trailer (circle one) Own/Rent (circle one)
Landlord’s Name: _________________________________ Telephone: ___________________________________
Fenced Yard: ______________ Type of fence and height: ______________________________________________
Have you owned a Doberman before? ______________________________________________________________
Why do you want to adopt a rescued Doberman? ______________________________________________________
Preferences (circle) Male Female No Preference
Cropped Natural Ears No Preference
Black/Tan Red/Rust Blue Fawn No Preference
Puppy 2-5 yrs Senior No Preference
List other preferences:___________________________________________________________________________
Where will the dog be kept during the day? (circle) House Yard Crate Basement
Where will the dog be kept at night? (circle) ) House Yard Crate Basement
Do you have (circle) Kennel Run Dog House Crate
How many hours will the dog spend alone per day? (circle) 2-4 4-8 10-12
Dobermans are high energy dogs. What are your plans for exercising your dog? ____________________________
_____________________________________________________________________________________________
Will you enroll your new dog in an obedience class? __________________________________________________
Would you be willing to let a member of Blue Ridge Doberman Rescue visit your home by appointment? ________
If no, why not? ________________________________________________________________________________
Please provide:
A personal reference (not related to you) with telephone number: _________________________________________
Your veterinarian’s name, address and telephone number: _____________________________________________
Have you ever been convicted of animal cruelty, neglect or abandonment? ______________________________
All of the above information is true. I hereby give permission to Blue Ridge Doberman Rescue to contact my personal reference and veterinarian listed above to inquire regarding my previous pet care experience. I understand that Blue Ridge Doberman Rescue reserves the right to refuse any applicant.
Signature of Applicant (all applicants must be over the age of 18 years) Date
Please review your application for completeness and accuracy. Blue Ridge Doberman Rescue will not consider incomplete applications.
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