Page 1 - Your Info Page 2 - Housing & Family Page 3 - Other Pets Page 4 - About This Dog Page 5 - References & Agreement Order Number Your Contact Information First Name * Middle Name Last Name * Current Occupation: * Employer Name: * How long have you worked for this employer? * Current Address: (the address of the home where the adopted dog will reside) * How long have you lived at this address? * Daytime Phone: * Evening Phone: * Best time to call: * Email Address * Residence What type of residence do you live in? * House Apartment Farm Do you own or rent? * Own Rent ** If you rent, please describe the rules regarding pets and provide the landlord's name and telephone number. How long have you lived at your current address? * ** If less than 2 years at current address, please list previous address. Please select the description which best describes your household: * Active Noisy Quiet Average Who is this pet for? * Yourself Family Other ** If other, please explain: How many adults reside in the home where the adopted dog will reside, and what is their relationship to you? * How many children reside in the home where the adopted dog will reside, and what are their ages? * Does anyone in your residence have a known allergy to dogs? * No Yes ** If yes, please explain how they plan to manage their allergies: Is everyone in your home in agreement with the decision to adopt a dog? * No Yes Do you have time to provide a dog with adequate love, training, attention and exercise? * No Yes Do you have a fenced yard? * No Yes, attached to the house Yes, not attached to the house ** If you have a fenced yard, please describe approximately how large the yard is and how tall the fence is: Family How many adults are in your family, what is their relationship to you, and how much interaction will they have with your dog? * How many children are in your family, what are their ages, and how much interaction will they have with your dog? * Other Pets Do you have any other pets this dog would live with? * No Yes ** If yes, please list cat/dog/other and how many: Are all of the pets in your household up to date on vaccinations? * No Yes I do not have other pets ** If your pets' vaccinations are not up to date, please explain: Are all of the pets in your household spayed / neutered? * No Yes I do not have other pets ** If not all of your pets are spayed / neutered, please explain: Have you adopted from a rescue or shelter before? * No Yes ** If you have adopted before, please list cat/dog/other: ** If you have adopted before, please list from whom/where: ** If you have adopted before, where is the pet now? Have you ever surrendered a pet? * No Yes If you have surrendered a pet, please explain: Have you ever had a pet euthanized? * No Yes ** If you have euthanized a pet, please explain: Have you ever lost a pet to an accident? * No Yes ** If you've lost a pet to an accident, please explain: How do you discipline your pets and why? * Veterinarian Do you have a regular veterinarian? * No Yes ** If you have regular veterinarian, please provide your veterinarian's name, the clinic name, address and phone number: By providing the Cavalier Doberman Pinscher Club with this information, you are authorizing a representative of the Cavalier Doberman Pinscher Club to call or visit your veterinarian. Please call your veterinarian in advance and ask them to authorize release of information to a representative of the Cavalier Doberman Pinscher Club. About The Dog You Wish To Adopt Please describe where the dog will spend the day: * Please describe where the dog will spend the night: * What is the average number of hours the dog will spend alone? * Who will have primary responsibility for the dog? * Who will have financial responsibility for the dog? * Do you agree to provide regular health care by a Licensed Veterinarian? * No Yes Do you agree to keep the dog as an indoor dog? * No Yes Do you currently participate in any canine sports? * No Yes ** If you currently participate in canine sports, please list them: Have you ever earned any title on a dog? * No Yes ** If you've earned a title on dog, please list them: When the dog goes outside, how do you plan to supervise it? * Do you agree to contact the Cavalier Doberman Pinscher Club if you can no longer keep this dog? * No Yes Are you willing to let a representative of the Cavalier Doberman Pinscher Club visit your home by appointment? * No Yes How did you hear about the dog that's up for adoption? * Personal References Please list two people who are familiar with both you and your current or previous pets (if applicable). Reference #1 Name: * Reference #1 Address: * Reference #1 Phone: * Reference #1's relationship to you (relative, neighbor, friend, etc.) * Reference #2 Name: * Reference #2 Address: * Reference #2 Phone: * Reference #2's relationship to you (relative, neighbor, friend, etc.) * By typing your name in the "Signed By" field below and clicking the Submit button, you are providing an electronic signature stating that all of the information you have given in the application/questionnaire is true and complete. By providing names, addresses, phone numbers of offices, agencies and individuals, you authorize representatives of the Cavalier Doberman Pinscher Club to contact anyone listed in the application (current or previous landlords, vets, personal references, etc.) to determine your suitability to adopt this dog and will notify them in advance. You also understand that the Cavalier Doberman Pinscher Club has the right to disapprove your application without any notice. You understand that the dog up for adoption is intended as a residential pet who will reside inside your home. You understand that, if approved, you will provide the dog with quality dog food at least twice per day, plenty of fresh water, indoor shelter, training, annual physical examination and vaccinations under the supervision of a licensed Veterinarian. You also understand that if approved for adoption, you will sign an adoption agreement/contract prior to taking possession of the dog in which you agree this dog will not live outdoors in a kennel or run, will not be tethered outdoors, will never be offered for sale, and will be returned to the Cavalier Doberman Pinscher Club if for any reason you have to re-home/surrender this dog. Furthermore, you understand a maximum adoption fee of two hundred and fifty dollar ($250) will be collected at the signing of the adoption agreement/contract and will be used by the Cavalier Doberman Pinscher Club for their Rescue Fund. Signed By:
