What is the best time to call you?

What is your occupation?

Personal reference:

Relationship

Personal reference phone (NNN-NNN-NNNN):

Do you own or rent your home?
Own
Rent

Who carries your homeowner's or renter's insurance? (Be sure to check with your carrier - some insurance companies exclude certain breeds of dogs.)

If you rent, do you have the property owner's permission to keep a dog?        Yes No

Landlord's name and phone number:       

Do you live in a
House
Apartment
Trailer
Other         Please describe:   

How long have you lived at this address?       

If less than one year, please give previous address       

Do you have a fenced yard?        Yes No

If yes, please list height and type       

Does fencing completely enclose the yard for the dog?        Yes No

If there is no fence, how will you handle the dog's exercise and toilet duties?

Do you have a separate kennel run?        Yes No

If yes, list height and size

How many adults in the household?       

How many children?       

Age(s) and sex of children

Are there regular visitors to your home, human or animal, with which your new dog must get along? Please describe:

Do you own other dogs?        Yes No

Are other dogs spayed or neutered?

How many other dogs?       

Please list breed(s), age(s) and sex of any other dogs

Do you own cats?        Yes No

How many cats?       

Any other animals?

Do you have a regular veterinarian?        Yes No

Vet's name:

Vet address and phone:

How many dogs have you owned in the past five years?       

Please explain the circumstances if you no longer have these dogs:

Have you owned a Doberman before?        Yes No

Why did you choose the Doberman?

Select all planned activities for this dog:
Pet                      Guard                    Obedience                Agility               
Search & Rescue          Conformation             Protection (Schutzhund) 

Color preference:
Red
Black
Blue
Fawn (Isabella)
No preference

Where will the dog spend its day?
Loose indoors
Crate
Basement
Garage
Fenced yard
Loose outdoors
Tied up outside
Kennel run outside
Other