First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Cell Phone

Volunteer Name*

Volunteer E-mail*

Date of Home Visit*

Home Setting*
Choose one: Rural Urban Suburban Other

In what type of home is this?
Choose one: Apartment Duplex Other Single Family Townhouse/Condominium

Does applicant own or rent home?*

Overall assessment of home? (safe/some hazards/numerous hazards/unsafe/other - please explain)*

What is the applicant looking for in a Doberman/dog? Color, age, sex, activity level, specific looks such as docked or cropped, cat savvy, good with children, protective, barker, none-barker, be specific! *

What form of discipline do you practice?

List all the reasons or behaviors you are unwilling to work with. *

Does applicant have past experience with Dobermans?*

Is there a yard? How big is the yard, please describe.*

If there is a yard, is it completely fenced?
Choose one: Yes No Not Applicable

What is the height of the fence?

What type of fence do you have?
Choose all that apply: Chain Link Invisible No fence Other Partial fence Privacy

If no fence, please explain your plan in detail how your new pet will be allowed to bathroom and play outside. We do not allow tie outs due to the danger associated with them.*

Were any children or pets present during your visit? Describe interaction with you home visit person and any dog you brought with. *

Has applicant provided registration confirmation of obedience class, or has applicant determined a training facility for future training?*

Is applicant familiar with crate training and are they willing to crate dog?*
Choose one: Yes No Not Applicable

Where will the animal sleep? *

All pets in the home must be on heart worm preventative. Are your current pets on heart worm preventative?*

Where purchased and what vet prescribed since it is a prescription. Ask to see meds.*

What happened to previous pets? Please list all past pets you have owned and what happened to them. Please explain in detail*

Where will animal be kept when you are not home? How many hours per day will animal be alone?*

Would you feel comfortable leaving your dog with applicant? Please explain.*

General information - please provide a basic summary of the family environment.*

What are your concerns (if any) after visiting the home? Were they resolved at end of home visit?*

Please provide a summary and describe anything else that should be noted when considering applicant.*