Adoption Application

adoptionapp

PIXIE’S LEGACY - A Doberman Rescue
Doberman Pinscher Club of Western New York
ucdxpixie@heelynndobes.com

Please fill out this application form completely.

Your answers on this application will help us to match your needs with the Dobermans in our program. Once we receive your completed application, we will review it and someone will be in contact with you as soon as possible. Please note that it may take a few days to process your application and we do require an adoption fee of $175 for each dobe - this money is used to help us pay for medical treatments, boarding and other expenses incurred in rescuing other dobes.

We are only able to adopt to homes where we are able to do home visits. If you are outside our area, we will try to put you in touch with a rescue closer to your home.

Name: ____________________________________________________________
Address: __________________________________________________________
City/ State/ Zip: _____________________________________________________
Telephone Numbers (home): __________________ (work): ___________________
Email address: ______________________________________________________
Occupation: ________________________________________________________
Veterinarian: ________________________________________________________
City/ Phone: ________________________________________________________
Please include the name and contact information for three personal references.

Would you prefer a male/ female/ either (circle one) Doberman?
Please indicate your color preferences (by number with 1 for most preferred and 4 for least preferred or circle no preference)
black/rust red/rust blue/rust fawn/rust no preference

Do you have a preference for the age of the Doberman? (circle all that apply)
Under 1 year 1-3 years 4-6 years 6-8 years over 8 years

Do you have a preference for the ears of the Doberman?
cropped natural no preference

Do you have a preference for the tail of the Doberman?
docked natural no preference

What is it about Dobermans that have generated your interest in the breed?

List your plans/ goals for this dog (pet/ companion, obedience, protection, work, etc.).

What other breeds have you considered?

For your needs, what are the three characteristics that you find most appealing about a new Doberman? (Choose three)
Active Playful Independent Protective Dominant Submissive
Shy Calm Intelligent Loving Aggressive Other

PIXIE’S LEGACY recommends that all new adopters take their new dobe to at least an introductory obedience training class. Do you intend to go to training class with the new dobe? If you do NOT intend to go to training, please provide a brief explanation as to why.
Yes
No, because

Which of the following best describes you current residence? (Circle one response)
Home Apartment Mobile home Duplex/ Townhouse
How long have you lived here?
Do you rent / own (circle one)?
If you rent please include your landlord’s name and phone number. You will also need to include a copy of your lease.

Do you have access to a fenced area to exercise the Doberman?
If yes, (Describe the fence - size, type, etc.)

If you do not have a fenced in area, how do you plan to exercise the Doberman?

Approximately how many hours each day will the Doberman be alone?

List the people who currently live at this residence? Include their name, their age (and sex for children) - you must include yourself.

Are there any children that visit frequently? Please give age and sex for each child.

Who will take care of this Doberman?

Will you have your Doberman vaccinated against infectious diseases annually by a veterinarian?
If not, why not?

Will you maintain your Doberman on heartworm preventative?
What type?

Are all household members aware of your intent to get a Doberman?

List the animals you have had in the last 3 years. Include the name, type/ breed, sex, age, how long owned and where they are kept. If you no longer have the animal what happened to them?

Does anyone in the household have any known allergies to animals?
If yes, please explain.

Have you owned a Doberman before?
If yes, please provide us with a brief history of your Doberman.

How did you find out about our rescue program?

Would you consider volunteering for PIXIE’S LEGACY?
If yes, in which of the following areas?
Fostering Transportation Home visits Fund raising Other

I certify that the above information is true. I certify that the Doberman will reside in my home as a pet. I will provide adequate food, water, shelter, training, affection and medical care. I understand that I will be required to sign an Adoption Contract. This application will become part of these agreements, and any misrepresentation in this agreement will constitute a breach of the Adoption Contract. I understand that PIXIE’S LEGACY is not responsible for any damage, accident, or injury resulting from the placement of a Doberman into my household. If any lawsuit should result as a result of this Doberman adoption, adopter agrees to pay all court fees.

Signature: _________________________________ Date: ________________

Please fax your completed application to:
Lynn Winter
518-483-3506
ucdxpixie@heelynndobes.com

Adoption Application


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