Name:
Email Address:
Complete address including Phone Number
How many members in your household including pets? Please include ages of your children, if any.
Residence - please answer all that apply
Own Home
Rented
Single Dwelling
Apartment
Condo
Acreage
Fenced Yard
What is the longest period of time the puppy would be left at home during the day?
Please indicate your requirements for a puppy.
Male
Female
Performance prospect (Obedience,etc.)
Show Prospect
Companion
Please give us a brief idea as to what you are planning to do with your Puppy? for example companion, I like to jog with my dog, OR Agility etc.
Would you be interested in an older dog, if available?
Yes
No
Only if under 1 year
Have you owned a Dog before?
Have you owned a Poodle before?
How long have your previous pets been with your family?
Are you planning to take your new puppy to puppy and/or beginner Obedience classes?
Yes
No
Need more information
Please provide 3 references and their phone numbers. If you have a current Veterinarian and Groomer for your pets please include them as one of your 3 references.
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