March 17, 2015 Amanda Our Poodles Ruger Application Name of Dog (or Dogs) that you are applying for adoption?Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneAgeYour Relationship status# of Adults in householdNumber / Ages of childrenYour Work InformationEmployed ? Employer's Name? How long ? Position ? Spouse Work InfoSpouse Employed ? Employer's Name? How long ? Position ? *Do You Own or Rent?*OwnRentIf renting, name & phone # of landlordHow long at this address?Do you have a fenced in yard?*YesNoHeight Of FenceWhat type of fence do you have?How long will the dog be left alone each day?Other Pets / Additional Information / CommentsDo you own a pet now?*YesNoIf so, please list them here with their name, age and breed....Have you owned one in the past?YesNoThird ChoicePlease supply vets name and phone number as well as the last name that the pet was under at that timeHave you ever re-homed a pet and if so, what was the reason?If you have never re-homed, if you had to, what reasons would those be for? (house training issues, aggressive behavior etc)I acknowledge that Poodle Patch may request a home visit and or photos per their request.* Yes What type of food would you feed your Poodle?When you are not home, would you crate your dog, leave loose in the house, or leave outside un-attended?List at least "2" references that we may contact and their contact numbers*Contact NamePhone Number or email address Additional Contact InformationVeterinarian's Contact InformationPlease provide name & phone number.Groomer's Contact Information - Please include ALL of this information - Name of Groomer, Phone number of Groomer, Name of Pet and Last Name that the pet was listed under.Please provide name and phone number.Email Are you human?Please enter the characters exactly as you see them in the above image. This field is case sensative.NameThis field is for validation purposes and should be left unchanged. Δ
