KC poodles of PA Purchase Adoption


If you’d like a puppy from us this form must be completed and sent to us via text 6107628575

Or email


Contact Information

Full name: ______________________________________________________________

Occupation: ______________________________________________________________

Address: ______________________________________________________________

How long at this address: ___________________________________________________

Daytime Phone: ___________________________________________________________

Evening Phone: __________________________________________________________

Best time to call: ___________________________________________________________

Email address: __________________________________________________________

Family & Housing

How many adults are there in your family (their relationship to you)?


How many children (ages)?


What type of home do you live in single family, town home, apartment, farm, etc.?


Please describe your household: __ Active __ Noisy __ Quiet __ Average

If you rent, please give the rules governing pets and the landlord’s name and number:

(by providing this information you are allowing KCpoodles to contact your landlord please inform them of this call so they will speak with us)

Is everyone in agreement with the decision to adopt a dog? _________________________

Do you have time to provide adequate love and attention?


What are your daily plans for exercise?


Are there any smokers in the home?


Other Pets

What other pets do you have (specify type and number)?

Are these pets up to date on vaccines? ______________________________________

Are these pets spayed/neutered? If not..why?____________________________________


Have you ever surrendered a pet? If so, why?


Have you ever had a pet euthanized? If so, why?


Have you ever lost a pet to an accident?


How do you discipline your pets and why?



Do you have a regular veterinarian? __ Yes __ No

Veterinarian’s name: _______________________________________________________

Clinic Name: _______________________________________________________

Clinic Address: ________________________________________________________

Clinic Phone: ________________________________________________________

(Providing KCpoodles with this information you are allowing KCpoodles to call your vet. Please call your vet and ask them to authorize the release of information to KCpoodles)

About the Dog You Wish to Adopt

What is your idea of an ideal dog and why?

Desired age: __________ Desired Size: _____________________________________

Desired breed: _______________________________________________________________

Breed you would not adopt:_____________________________________________________

Desired sex: _

Willing to adopt: __ outgoing/hyper dog __ shy dog

__ dog that needs regular medication __ dog that needs training

__ dog that needs grooming __ None of these

Where will the dog spend the day? (describe)


Where will the dog spend the night? (describe)


Number of hours (average) dog will spend alone? _________________________________

Who will have primary responsibility for this dog's daily care? _______________________

Who will have financial responsibility for this dog? ________________________________

Do you agree to provide regular health care by a Licensed Veterinarian? __ Yes __ No

Do you agree to keep the dog as an indoor dog? __Yes __No

When the dog goes out, how do you plan to supervise it? Fenced yard?


Personal References

Please list someone who is familiar with both you and your pets.




Relationship (relative, neighbor, friend, etc.):




Relationship (relative, neighbor, friend, etc.):

All of the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.

___________________________ _________

(Signature) (Date)