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Adoption Form

Michigan Standard Poodle Rescue — P.O. Box 1882, Bay City, MI 48707

"*" indicates required fields

About You

Your Full Name*

Your Age*

Spouse or Partner Name*

Spouse or Partner Age*

Home Address*

City*

Zip Code*

Email Address*

Work Phone*

Home Phone*

Cell Phone*

Your Place of Employment*

Spouse Place of Employment*

Do either of your jobs require travel?*

Yes

No

About Your Home

Please complete this section for the household in which your dog will reside.

Type of Residence*

House

Condo/Townhouse

Trailer Home

Dormitory

Apartment

Other

If Other, please specify residence type*

If you are a renter or live in a condo, does your landlord/association allow dogs?*

Yes

No

Name of Landlord or Condo Association*

Landlord/Association Phone Number*

How long have you lived at this address?*

Do you have any plans to move in the next few years?*

Yes

No

How many times have you moved in the past five years?*

What would you do if you moved to a residence where dogs are not permitted?*

Describe your yard*

No yard

Unfenced yard

Partially fenced yard

Completely fenced yard

Fence Height*

Fence Material*

Wood

Chain Link

Brick

Other

If you do not have a fence, do you agree to keep your dog on a leash at all times outside?*

Yes

No

About Your Family

How many adults live in this household?*

How many children live in this household?*

Ages of children in this household*

Number of children who visit*

Ages of children who visit*

Are all members of your household in agreement about adopting a dog?*

Yes

No

If no, who and why?*

Is anyone in your home nervous or unsure around dogs?*

Yes

No

For whom would you be adopting this dog?*

Who will be the primary caregiver for this animal?*

Who will be financially responsible for the animal?*

Are you willing to have all members of your household come to meet the animal(s) in which you are interested?*

Yes

No

Do any members of your household have asthma, or have allergies to dogs?*

Yes

No

If yes, who has asthma or allergies?*

For how many hours would the dog be alone during the day?*

Please consider what time you leave for work and what time you return home.

About Your Pet(s)

List all current pets in your household.

Current Pets*

Name

Species/Breed

Spayed/Neutered

Age

Gender

Owned How Long?

Vaccines Up to Date?

If you have a cat, does it get along with other dogs?*

Yes

No

If you have a cat, is it declawed?*

Yes

No

If you have a dog, does it get along with other dogs?*

Yes

No

What veterinary hospital do your animals go to?*

Are you experiencing any difficulties with your current pets in terms of health or behavior?*

Yes

No

Please describe any difficulties with current pets*

Pet History

Have all of your family members been around dogs?*

Yes

No

Have you had the experience of being primary caregiver to a dog?*

Yes

No

Have you ever given a pet away, given it to a shelter or rescue group, returned it to a breeder, or sold it?*

Yes

No

Have you ever had a pet for a short period of time and it did not work out?*

Yes

No

Have you ever had to retrieve your animal from a pound, shelter, or animal control facility?*

Yes

No

Have you had a dog that gave birth?*

Yes

No

Pets Owned Over the Past 10 Years

Pets Owned in Past 10 Years*

Name

Species/Breed

Spayed/Neutered

Owned How Long?

What Happened to Pet?

Plans for Your New Pet

Will the dog live:*

Indoors

Outdoors

Either Indoors or Outdoors

Not Sure

Where will the dog be when nobody is home?*

Indoors

Outdoors

Either Indoors or Outdoors

Where will the dog be when all have left the house?*

Longest amount of time the dog will be left alone at any given time?*

Where will the dog sleep?*

How often and where will you exercise the dog?*

What veterinary practice do you plan to use? (Name)*

Planned Veterinary Practice Phone*

If you adopt an animal who has not been spayed or neutered, do you:*

Intend to have it spayed/neutered

Intend to let it have puppies

Not Sure

Are you aware that some dogs require a period of weeks or even months to adjust to their new home?*

Yes

No

Are you willing to allow for this adjustment period?*

Yes

No

Are you willing to bring your pet to a veterinarian for yearly exams and vaccinations?*

Yes

No

Are you able/willing to pay for emergency care, which could result in a bill of $200 to $1,000 or more?*

Yes

No

Are you able/willing to pay for all pet expenses including veterinary care, supplies, toys, boarding, grooming, food, etc.?*

Yes

No

Are you able to commit to providing a home for a dog for the life of the dog?*

Yes

No

What circumstances might justify giving up a dog? (check all that apply)*

Baby

Moving

Shedding

Want to travel

None

Other

If Other, please describe circumstances for giving up a dog*

If your dog exhibits behavioral or adjustment issues, would you be willing to seek the advice of a MSPR representative?*

Yes

No

Would you be willing to pay for obedience or behavioral sessions?*

Yes

No

When away or traveling overnight, who cares for your pets?*

What type of food and treats do you feed your dog?*

Preferences

I prefer a dog that is:*

Small

Medium

Large

Any size

Preferred energy level:*

High

Medium

Low

Reasons for adopting (check all that apply):*

Companionship

Watch dog

Other

I prefer a dog who is (check all that apply):*

Senior

Puppy

Very active/energetic

Male

Female

Hypoallergenic

Indoor only

Indoor/outdoor

Mainly an outdoor dog

Mellow/quiet

Lap dog

Likely to be housetrained

When it comes to relating to dogs, I consider myself:*

Strict - a strong leader (dog must sit for a cookie and follow my rules)

Lenient - easily coerced by the dog (looks cute so gets a treat without sitting, can jump on couch uninvited)

Somewhere in between

My ideal dog would:*

Bad doggie habits I cannot tolerate:*

Please share anything you would like us to know about the new dog you would like to add to your family:*

Do you have any experience with dogs rescued from puppy mills?*

Yes

No

If yes, please explain your experience with puppy mill dogs:*

We deal primarily with Standard Poodles. Do you have experience with this breed?*

Yes

No

If yes, please explain your experience with Standard Poodles:*

Would you be willing to have an in-home visit by a MSPR representative both before and after you have adopted from us?*

Yes

No

Personal References

Please provide three personal references.

Reference 1 - Name*

Reference 1 - Relation*

Reference 1 - Phone Number*

Reference 2 - Name*

Reference 2 - Relation*

Reference 2 - Phone Number*

Reference 3 - Name*

Reference 3 - Relation*

Reference 3 - Phone Number*

Additional Information

Please provide any additional info that relates to adopting a poodle that may be notable:*

Bay City, Michigan | info@michiganstandardpoodlerescue.com | (989) 450-4009

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