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Topics: Dog, Pet, Poodle Pages: 2 (324 words) Published: April 10, 2013
The Poodle Patch and Friends
Standard Poodle & Non-Poodle Rescue of Texarkana
Adoption Application

Date: Name of pet applying for: Lilly's Kitten 3 Personal Information|
Name:| Smith |Tara|D|
Last|First|M.I.|
Address:| 4341 Horizon North Pkwy | 526 |
Street Address (no P.O.s)|Apartment/Unit #|
| Dallas |TX|75287|
City|State|ZIP Code|
Home Phone:| 9728902938 |Alternate Phone:| |
E-mail Address:|taradenise@msn.com|
Age:| 26 |Relationship Status:| Single |
Adults in Household:| 1 |Number/Ages of Children:| 0 |
Place of Employment:| Cape Buffalo Grille|For how long?|5 Yeara| Do you rent or own?| rent |How long at this address?|1 Year| If renting, may we contact your landlord?| yes |Name/phone:|Brazos 9722504341| Fenced yard?| no |Type of fence:|N/A|

Size of fenced area:|N/A|Fence height:|N/A|
How long will the dog be left alone each day?| Indoor cat| If no fenced yard is available, where/how often will the dog be taken outside for exercise or to relieve him/herself?| |
|
Veterinarian’s Contact Information|
Name:| Banfield|Phone:| 9722506428 |
||
Address:| Park Blvd|
|Street Address||
|Dallas|TX|75287|
|City|State|ZIP Code|

Groomer’s Contact Information|
Name:|Pet's Smart|
||||
Address:| Park Blvd |
|Street Address||
|Dallas|TX|75287|
|City|State|ZIP Code|
||||
References|
Please provide contact information for two references not in your household.| Name:| Niki Whitham |Phone:|4693710299|
||
Address:| |
|Street Address||
| Dallas |TX|75287|
|City|State|ZIP Code|

Name:| Lindsey Nall|Phone:|9729652721|
||
Address:| |
|Street Address||
| McKinney|TX| |
|City|State|ZIP Code|
||||
||||
Other Pets /Additional Information/Comments|
Please list, on an additional sheet, all other pets in your home. Include the type...
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