Last Name:

First Name:

DOB:

Last Name:

First Name:

DOB:

Address:

Apartment #:

City:

State:

Zip Code:

Home Phone:

Cell Phone:

Email Address:

Do you own?

Rent?

How long have you lived at this address?

Any plans to move in the near future?

Landlord’s/Condo board’s name:

Landlord’s/Condo board’s phone:

How were you referred to Faustina Toy Poodles?

Number of adults in the household:

Relationships:

Have all the adults in the household agreed to this adoption?

Yes                                No

Number of children in the household:

Ages of children:

Have the children had pets before?

Do you expect your current family situation to change?

Is anyone in the household allergic to pets?

Yes      No      Who?

Why would you like to adopt an animal from us? (Check all that apply)

Companion for self Gift

Companion for child Watch dog

Companion for another pet

Companion for another household member

Employer:

Position held:

Address:

City:

State:

Zip Code:

Name

Breed

Age

Gender

Spayed/Neutered

Where are they?

 M          F

 Y            N

 M          F

 Y            N

 M          F

 Y            N

Have you ever given an animal away or relinquished an animal to a shelter?

If yes, what were the circumstances?

Veterinarian’s Name:

Veterinarian’s Phone:

When was your current pet’s last visit to a veterinarian and why?

How long have you been looking for a pet?

What will you feed your new pet?                                     How often will you feed your new pet?

How much time are you prepared to allow for your new pet to adjust to your home?

Are you able to afford a bill of $200-$800 (or more) for emergency veterinary care?     Yes      No

How much do you expect to spend on maintenance/grooming for your pet in a year?

Are you committed to providing a responsible home for your pet’s entire life (15+ years)?     Yes    No

If you have to move, what do you plan to do with your pet(s)?

Who in the household will be the dog’s primary care giver?

In case of emergency, who will care for your dog?

Where will the dog be kept during the day?                             During the night?

How many times per day do you plan to take your dog outside?

How do you plan to house train your dog?

Do you have a fenced in yard?    Yes     No                   If yes, what size and what type?

How many hours per day will your dog be left alone?

What would you do if your dog develops a problem with:

Digging:

Barking:

Chewing:

Separation Anxiety:

Aggression: