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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:|[e-mail]|
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?| |
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Veterinarian’s Contact Information|
Name:| Banfield|Phone:| 9722506428 |
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Address:| Park Blvd|
|Street Address||
|Dallas|TX|75287|
|City|State|ZIP Code|

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

Name:| Lindsey Nall|Phone:|9729652721|
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Address:| |
|Street Address||
| McKinney|TX| |
|City|State|ZIP Code|
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Other Pets /Additional Information/Comments|
Please list, on an additional sheet, all other pets in your home. Include the type (dog, cat, etc.), breed, age, sex, and whether each animal has been neutered or spayed.You may also use this space to provide additional information you feel may be pertinent. |
Return completed form to The Poodle Patch and Friends for consideration. [e-mail][->0] We reserve the right to refuse adoption for any reason.

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