Dog Intake Form

Dog Intake Questionnaire

Please read
"Giving Up Your Dobe"
before you proceed.

We hope that we will be able to assist you in placing your Doberman by taking him/her into our rescue program. We do not operate a kennel facility. All dogs in our program are living in qualified foster homes as temporary members of our foster families. Foster space in our program is very limited so we may not be able to take your dog in quickly. Therefore, we encourage you to continue to seek alternative placement for your Doberman. If you do place your Doberman elsewhere, please contact us so that we can remove him/her from our waiting list. In general, dogs from shelters, humane societies and veterinary clinics are given priority. We do accept owner turn-ins ONLY when space is available.

We ask that private owners who are turning in a Doberman make a donation to DRNC to help cover the costs we incur while finding a suitable home for the dog. Also, for owner turn-ins, we require that current veterinary records be presented with the dog, verifying that he/she is current on vaccinations, is spayed/neutered, and is heartworm negative (if claimed on this form to be so). Due to limited volunteer time and budget, we require that owners requesting to turn their dogs over to us must be willing and able to bring the dog to the Raleigh/Durham/Chapel Hill, NC area.

DRNC works solely with purebred Dobermans, therefore we are unable to accept mixed breeds.

We ask that you answer the following questions regarding your dog. Please be honest and complete in your answers. We fully realize that dogs are not perfect and we are willing to work with some problems.

In addition to answering these questions, please email photographs of the Doberman to intake@hope4dobe.org.

In order to receive a response from us, you MUST supply your email address in the field provided on this form.

By completing and submitting this form, you are stating that you are the legal owner of this Doberman, that you are at least 18 years of age, and that all the information (to your knowledge) is true and correct.

Your Full Name:

Name of Organization, if Applicable:

Street Address:

City State Zip

Phone Number (specify: home/work/cell):

Email Address:

Name of Dog (if known):

Approximate Age of Dog:

How Long Has This Dog Been in Your Custody?:

Sex of Dog (male/female):

Reproductive Status of Dog (intact/neutered/spayed/unknown):

Color of Dog (black/red/blue/fawn/albino):

Style of Ears (cropped/standing; cropped/flopped; natural):

Style of Tail (docked/natural):

Does This Dog Have Any Basic Training?
(housebroken, crate-trained, leash-trained, formal obedience class, etc.):

Has This Dog Displayed Tendencies to Climb, Jump or Dig Under Fencing?:

Has This Dog Ever Displayed Aggression/Growled at/Nipped/Bitten a Human?
If yes, please explain why.

Is This Dog Good With Adult Men? (yes/no/unknown):

Is This Dog Good With Adult Women? (yes/no/unknown):

Is This Dog Good With Children Aged 0-8 Years? (yes/no/unknown):

Is This Dog Good With Children Aged Over 8 Years? (yes/no/unknown):

Is This Dog Good With Other Dogs?
(yes/no/unknown/good with females only/good with males only):

Is This Dog Good With Cats? (yes/no/unknown):

Is This Dog Current on Vaccinations? (yes/no/unknown):

What is the Heartworm Status of This Dog? (positive/negative/unknown):

Does This Dog Have Any Behavioral Problems?
If yes, please explain:

Does This Dog Have Any Medical Problems?
If yes, please explain:

Veterinarian's Name, Address, and Phone Number:

List the Positive Traits This Dog Has:

List the Negative Traits This Dog Has:

Why is This Dog Being Given Up?:

How Long Will You Be Able to Hold This Dog Prior to Placement?:

Will You Be Able to Transport This Dog to the Raleigh/Durham, NC Area?: (yes/no)

Where Did You Hear About Doberman Rescue of North Carolina?:

Any Additional Information or Comments:

Page last revised:
02/23/2011 10:05:27 PM

Doberman Rescue of North Carolina
P.O. Box 91421
Raleigh, NC 27675