Coastal Poodle Rescue

Tell Us About Yourself

This is how we will get in touch with you. Please be accurate and complete.

Prefix

First Name:

You must enter your first name.

Last Name:

You must enter your last name.

Age (Years)

Please enter your age in whole years, numbers only."

Street:

Please provide a primary physical address, no po boxes please.

City:

Please provide a city in your mailing address.

State

Zip Code:

Please provide a zip code in your mailing address.

County:

Home Phone

() -

Please enter your home phone number."

Work Phone

() -

Cell Phone

() -

Best Time to Call

Please tell when you prefer us to contact you by phone.

Email Address

Please provide a primary email address."

Occupation

Please tell us what you do for a living. If you are retired, type retired."

Would you like to subscribe to our newsletter?

Yes

No

About Your Home

This tells us about the dog's environment, and helps us to match you with the right dog.

Type of home you have

About how long have you lived there?

Please let us know how long have you lived at this address?"

Is the yard completely fenced?

Yes

No fence, or not completely fenced

Do you own or rent your home?

Own

Rent

If Renting:

Landlord Name

Landlord Phone

Do you have your landlord's permission to have a dog?

Yes

No

Not Applicable

About Your Family

This tells us about the dog's new "pack", and helps us to match you with the right dog.

Do you have small children (younger than age 10) who live at this residence?

Yes

No

Do you have small children (younger than age 10) who come to visit?

Yes

No

How many other dogs do you have?

Enter how many other dogs do you have?

Are the other dogs, if any, all sterile (spayed or neutered)?

Yes

No

Not Applicable

If you have other dogs, are they spayed/neutered?

Please describe the other animals in your household (ages, gender)

Tell us about your other animals. If you have none, enter Not Applicable.

Please describe the people in your household (names, ages, gender, relationship to you)

Tell us about yourself and the people in your household.

Your Dog's New Life

This tells us about how you plan to interact with the dog, and helps us to match you with the right dog.

How will you exercise your dog?

Tell us about how you plan to exercise this dog.

How do you plan to provide your dog with potty breaks?

Tell us about how you plan to provide potty breaks this dog.

About how long will the dog be alone?

How many hours a day will this dog be alone? If none, enter a zero.

Will this be an indoor or an outdoor dog?

Indoor

Outdoor

Where will the dog sleep?

Will this dog sleep with you, on its own bed, in another room, please describe.

Please describe your lifestyle, normal activities?

Please tell us about your lifestyle, such as how busy you are, how much you are home.

Your Previous Pets

This helps us to confirm that you can care for a pet responsibly.

Have you ever owned a poodle?

Yes

No

What happened to your previous pets? If they died, how and at what age?

Please tell us about the dogs you've had. If none, enter Not Applicable.

Questions about Poodle Care

These questions will help us to get to know you better. Please complete them honestly and completely.

Describe your use of flea/tick/heartworm preventions?

Describe your practices about using Heartgard or Advantage. Please answer completely.

What do you consider reasonable estimated annual vet costs?

What do you consider reasonable annual vet costs?

What do you consider reasonable estimated annual grooming costs?

What do you consider reasonable annual grooming costs?

Why do you want a poodle?

Why are you choosing to adopt a poodle? Please answer completely.

Describe your responsibilities as a dog owner.

Describe your understanding of the responsibilities of poodle ownership

Your References

Applications without references will not be considered. Be sure to provide area codes.

Vet Name

Please give us the name of your current or previous vet. If none, enter Not Applicable.

Vet Phone

Groomer Name

Please give us the name of your current or previous groomer. If none, enter Not Applicable.

Groomer Phone

Please give us the phone number of your current or previous vet, including area code. If none, enter 0.

First Reference Name

You must give 3 personal references

First Reference Phone

You must give a phone number, including area code, for your personal reference.

Second Reference Name

You must give 3 personal references

Second Reference Phone

You must give a phone number, including area code, for your personal reference.

Third Reference Name

You must give 3 personal references

Third Reference Phone

You must give a phone number, including area code, for your personal reference.

Miscellaneous

Other comments and questions you may have.

Please describe your preferences (size, age, gender, would you consider special needs)

Please describe the kind of dog you would prefer.

Remember, the more detailed your requirements, the longer it will take to match a dog to you.

How many hours are you willing to travel to get a dog? (one way)

Do you have any questions or comments?

How did you hear about us?

Please let us know how you heard about us?