Please answer the following questions and return this form at your earliest convenience so that you can be placed on a waiting list for a rescued dog.

Date:___________________

Name:_______________________________________________________________________

Address:_____________________________________________________________________

City:____________________________________________________State & Zip:___________

Phone:__________________________________Occupations:___________________________

1. Why do you want a Poodle?
   _______________________________________________________________________
2. What variety of Poodle do you want? Standard, Miniature, Toy, any variety? _________
3. Have you ever owned a Poodle before?______
   When?________________________________________
   What variety?__________________________
   Where did you get it?_____________________________
4. What happened to him/her?___________________________________________________
5. How many children at home?________
   Ages?_______________________________________________
6. Who will be responsible for the Poodle?_________________________________________
7. Do you rent?____Own a Home?____Apartment?____Are you moving?________________
8. Does your lease allow pets?____If moving, when ________________ Where____________
   ________________________________________________________________________
9. Do you have a fenced yard?___________________________________________________
10. Is the dog to be fenced in or let loose?___________________________________________
11. Do you intend to keep the dog primarily indoors or out? Please elaborate________________
    ________________________________________________________________________
12. Any allergies to pets?_________________________________________________________
13. Do you have other pets?_____What kind and sex?__________________________________
    __________________________________________________________________________
14. Where did you get your pet?___________________________________________________
    How long have you had him/her?________________________________________________
15. If you don't have a pet now, have you had a pet before?______________________________
    What kind and sex?_____________How long did you have him/her?____________________
    What happened to him/her?____________________________________________________
16. Are you aware of the grooming requirements of poodles?_____________________________
17. Have you discussed with your family the pros and cons of owning a Poodle?_____________
18. Have you asked yourself whether your lifestyle is so busy that you might not have the time
    or energy to properly care for a dog?_____________________________________________
    __________________________________________________________________________
19. Does everyone in your family want a dog?_________________________________________
20. What other breeds have you been contemplating?____________________________________
21. What is your family's overall reaction to owning a dog?_______________________________
22. Do you realize that a Poodle may live for 10-18 years and are you committed to care for it
    that long? _________________________________________________________________
23. Are you willing to attend obedience classes to train the dog?___________________________
    Which family members would be expected to assist with home training?__________________
24. Do you have a sex preference?________Which?____________________________________
25. Would you consider the opposite sex?____________________________________________
26. Would you be interested in an older dog?__________________________________________
27. Are you agreeable to returning the dog, should some unforeseen circumstance arise wherein
    you would no longer be able to keep the dog?_______________________________________
    __________________________________________________________________________
28. How did you find out about us?_________________________________________________
29. Your comments and suggestions:_________________________________________________
    __________________________________________________________________________

This comprehensive questionnaire helps us in placing the right dog with the right family.

Your Signature:______________________________________________Date:_________________

Please mail or e-mail (use cut and paste) this form to:Ms. Victoria Law at  [email protected]
or Laura Thistle at [email protected].  (All e-mails must contain a completed adoption application)

or  Mrs. Lynn Estaver,  6309 East Pilgrim's Rest Road , Warrenton, VA  20187