Application Form First Name (required) Last Name (required) Your Email (required) Address City State ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Home Phone Other Phone Age Do you have children? YesNo I want a... PetShow/Breeder Prospect Please explain why you want a poodle: What you would be your first, second, and third choice of color? First Second Third What sex would you prefer? MaleFemaleNo Preference Are you willing to spay/neuter your poodle? YesNo Are you willing to give life long love and commitment to this new family member and the best care that he/she will require to maintain a good health program through a licensed vet, a nutritionally balanced food diet, exercise and grooming when required. YesNo Additional comments or questions:
