Application for Adoption Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name of Poodle you are interested in adopting *Your Name *FirstLastAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeIf you reside outside of the United States, please contact us and we will send you an application to fill out. Email * days know and Phone *List names and relationship to you of ALL adults living in your home. *This Includes Spouse, Partner, Relatives And Roommates. If no other adults live in your home, please write None. If there are children living in the home or occasionally visiting, please list their name(s) and age(s). *If no children live in your home, please write None.Dwelling *HomeApartmentCondo/Townhouse/DuplexMobile HomeRent or Own *RentOwnHas your Landlord agreed in writing to allow you to have a dog on the premises?YesNoDo you have a securely fenced yard? *YesNo NOTICE: We DO NOT accept "Invisible Fencing." STOP HERE if that is what you use. How do you plan to keep the poodle from roaming, being run over by an automobile, or being stolen?Who will be the primary caregiver to the Poodle?Do you work outside the home? *YesNoWhat hours and days do you work? *Will someone be able to let the dog out while you are at work? *YesNoOr where will the dog be while you are at work? *Do other animals live in your home? *YesNoWhat are their weight(s), breed(s), temperament(s), and age(s)? Have you owned a dog in the past? *YesNoWhich breed? When? For how long? What became of the dog?Please describe why you want this poodle from Picket Fence Poodle Rescue *In the case of a life altering event, are you or a family member willing to return the poodle to us? *YesNoWe understand that unforeseen circumstances arise, and you or your family might not be able to keep the poodle. Please be sure to make those arrangements with your family or friends now. Please list your Veterinarian name and telephone number to be contacted *Personal Reference 1 (Name, relationship to you, telephone/email) *Personal Reference 2 (Name, relationship to you, telephone/email) *If you are interested in adopting a Standard Poodle, please provide the name and number of your groomerIs there anything else you would like us to know about you? *Do you have any questions about the dog you are applying for? *I certify that the information entered on this application is true. Enter your name and date. *Submit