First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone*
Work Phone* x
Cell Phone*
Alt Email*
Text/Pager Email*
Is this dog previously adopted from Doberman Rescue Minnesota? *
If no, where did you purchase this dog? Please include the breeder name and website.*
What is the name, age and breed of the dog you wish to surrender? *
Is the dog spayed/neutered? *
Does the dog have a docked tail or cropped ears?*
What are the dates of the last vaccinations? Please include Distemper, Rabies and Bordetella vaccination dates. *
Is the dog on monthly heartworm and flea/tick prevention? What is the date of the last Heartworm or 4DX test? *
Does this dog have any special needs?*
Has this dog lived with other companion animals? Please list breed and age. *
Has this dog lived with children? If yes, please list ages. *
Has this dog ever bitten another person or animal? *
If yes, please explain when and what happened.
Why are you looking to surrender this dog? *
Have you worked with a trainer to resolve any issues you may be having with this dog? *
Is this dog house trained?*
Is this dog crate trained?*
When do you wish to surrender your dog?*
I understand that by filling out this application does not guarantee placement with Doberman Rescue Minnesota. I also understand that Doberman Rescue Minnesota is foster based, and will require an open foster home should the dog be accepted into the DRM program. *