KC poodles of PA Purchase Adoption Application If you’d like a puppy from us this form must be completed and sent to us via text 6107628575 Or email [email protected] 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? _________________________________________________________________________ Veterinarian 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. Name: Address: Phone: Relationship (relative, neighbor, friend, etc.): Name: Address: Phone: 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)