Unfortunately, we are unable to consider re-homing dogs with

                                                                  serious medical conditions, due to the expense involved and

                                                                 due to the limited number of adopters available for these situations.

                                    Also, no dog will be considered for rehoming unless they are spayed or neutered.

 Date

Contact Information:

 Owner’s Name   

 Email address:  

 Phone #:           

 Cell #:              

 Address:  

  City, State, Zip    

  County               

Dog History:

Dog’s Name: 

Variety:  Standard (over 15 inches)    

               Miniature (over 10 inches, under 15)

               Toy (under 10 inches)

Is your dog a purebred poodle? Yes No     Do you have AKC papers? Yes No

Gender:  Male     Female      Spayed or neutered:  Yes No       Coat color 

 NOTE:  dogs must be spayed or neutered before an application for rehoming can be accepted!

Age:       Weight  

Where did you purchase or obtain your poodle?

     If you got your dog from a breeder, have you contacted the breeder about returning her/him to the

     breeder?  (Many breeders require this.) Yes No

Has your dog ever bitten anyone?     Yes No

     If so, what were the circumstances?

Does your dog have any behavioral problems (like aggression, separation anxiety, etc.)? Yes No

     If so, what are they?

Does your dog have any serious health issues? Yes No

  If so, what are they?

 Reason for the need to re-home this dog  

Personality and Behavior:

How would you describe the dog?  (check all that apply)

 Friendly     Playful         Stubborn    Needy    Loving    Calm  

  Shy           Aggressive   Obedient

When outside, the dog uses:   Free roaming      Is chained    A dog pen    Leash

                                                      Invisible Fence  Fenced yard  

Is your dog …

Friendly with other dogs?    Yes No                        

Obedience trained?            Yes No  

Crate trained?                    Yes No  

Housebroken?                    Yes No  

A barker?                           Yes No   

Leash trained?                    Yes No    

Good with cats?                  Yes No        

Good with kids?                  Yes No

Medical History:

Is the dog up-to-date with vaccinations?    Yes No  

    Date of last vaccination:      

Has your dog been heartworm tested?  Yes No    

    Date of last heartworm test: 

Does your dog currently take any other medications?  Yes No    

    If so, what conditions do they treat?

Does your dog have allergies?     Yes No    

    If so, what type of allergy? 

Does your dog have seizures?    Yes No    

    If so, what is the frequency of the seizures?

Veterinarian Information:

Name of Veterinarian:

  Phone:                        

      Address:

     City, State, Zip

     May we contact your veterinarian regarding the health history of your dog?  Yes No

    If so, please call your veterinarian and authorize her/him to release the history to us (Western

    Reserve Poodle Club) and inform them that we may be calling.  Thank you.

Groomer Information:

Do you have a regular groomer?     Yes No

    If so, please provide us with contact information for your groomer:

                Name          

                Phone Number