Fill and Sign the United States District Court Central District of California Form 53 Writable

Dobie Haven, Inc. Adoption Application Form Date: ______________ Name: Address: City: Email: ______________________________________________________________ ______________________________________________________________ _______________________ State: ________ Zip Code: ____________ ______________________________________________________________ PHONE NUMBERS Home: _______________ Work: _______________ Alternate: _______________ Mobile: _______________ Occupation: ____________________________________________________________ Company Name & Address: _______________________________________________ _______________________________________________ How long at present job? _________________________________________________ How long at previous job? _________________________________________________ How many children, their ages, or other people living in the home? ________________ ______________________________________________________________________ Have you ever given away or sold a dog? Yes / No (circle one) If “Yes” what was the reason? _____________________________________________ Have you ever surrendered a dog to a shelter? Yes / No Have you ever surrendered a dog to Animal Control? Yes / No Type of residence? (check one) House ~ Apartment ~ Mobile ~ Other ~ Do you own or rent your home? _________ If you rent, please enter the name and phone number of your landlord. ____________________________________________________________________ How long at your present address? (Months/Years) ____________________________ How long at your previous address? (Months/Years) ____________________________ May we visit your home? Yes / No (circle one) Do you have other animals at home? If so, what type, breed, ages, sex, and if they are spayed/neutered: _____________________________________________________ Where are the animals kept? ______________________________________________ Are you aware of ongoing expenses associated with a pet? Yes / No What are the necessary vaccinations for your pet? ____________________________ How do you prevent heartworms in a dog? __________________________________ How do you prevent fleas and ticks? ________________________________________ If you have a veterinarian now, what is his name? _____________________________ If you have used other veterinarians, what were their names? ____________________ ____________________________________________________________________ Do you have a fenced yard? Yes / No If “Yes” what type: ___________________ Fence Height: ________ ft Attached to your house? Yes / No Is your fence secure enough to prevent your pet from climbing out, digging out, jumping out? Yes / No How large is your yard? ____________________ What food do you feed your current dog? ___________________________________ Are you willing to take the dog to obedience classes if necessary? Yes / No How do you handle a destructive dog? ___________________________________ How do you handle a dog who digs? ___________________________________ How do you handle a dog who chews? ___________________________________ Where will the dog be housed during the day? ___________ at night? ___________ How long will the dog be left alone each day? ________________________________ How much time can you spend playing with and training your dog each day? ______ hrs Have you ever had a Doberman Pinscher? Yes / No If so, how long ago? ____ yrs What happened to the dog? __________________________________________ Please explain why you want a Doberman Pinscher: ________________________ ______________________________________________________________________ ______________________________________________________________________ I hereby certify that the above information is true and correct to the best of my knowledge: Signature: ______________________________________ Approved by: ____________________________________ Dobie Haven, Inc. 4002 Callicoate Corpus Christi, TX 78410 Fax: (361) 241-2737 www.dobiehaven.com Date: ______________