Derby Family Poodle

Thank you for your interest in Derby Family Poodle puppies.

We look forward to reviewing your application to see if we are a good fit for each other as a breeder and new puppy family. We realize this application is extensive, however it will truly help us choose appropriate and forever homes for our pups. Thank you for taking the time to share about yourselves, your family and your home. ~The Derby Family *If you need assistance in completing this form, please reach out via email: DerbyFamilyPoodle@Gmail.com

Your Contact Information
Full Name of Primary Applicant/ Care Taker for puppy *

First Name Last Name
Any other name(s) you have legally gone by? (Maiden or otherwise)
E-mail *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Your Occupation and typical work hours? *
Exact hours are not necessary. Ie. 40 hours weekly, rotating 12 hour shifts, 12 hours on 24 hours off, etc.
Spouse/ Partner's Name?

First Name Last Name
Spouse/ Partner's Cell Number
Spouse/ Partner's Occupation and work hours?
Exact hours are not necessary. Ie. 40 hours weekly, rotating 12 hour shifts, 12 hours on 24 hours off, etc.
How Did You Hear About Derby Family Poodle? *
Example: Friend or Family (please enter their name so we can make a connection), Facebook (what page?), AKC Marketplace, GoodDog, etc.

Puppy Preference
1st Gender Preference *

Male Female
Would you consider the other gender if your 1st preference is not available? *

Yes No
Timeline for getting a Puppy? May 2021 for the current litter. If not this litter, what is your next preference? (Ie. 6 months, 1 year)
Current litter was born 3/10/2021. Go home dates will be around May 8 - 15, 2021. *Pending any vet reommendations or needs of the litter. If you are traveling to get the puppy we will speak to you individually about the date(s). Puppies will NOT leave prior to a minimum of 8 weeks old.
Do you have your eye on any one or two puppies in particular? If so, which one(s) and what is it about them? *
Colors- Which color(s) do you prefer? Example: Light, Medium, Dark, Abstract Markings, Apricot, More Red, etc. *Color choice will be taken into consideration, however we believe that temperament is what helps to make the best match for puppies and families.
*Please understand that color is an act of nature. Even though Dam and Sire have been color tested, this is their first litter together, and nature is always in control.

Ownership Commitment
This litter will be available to go home around their 8th - 9th week. Will you be able to take this puppy home during this time? *
Will you be able to pick up your puppy in person in Fuquay Varina, NC? *
*If you would like to fly in to RDU (Raleigh Durham Airport), or to get a Flight Nanny to fly with your puppy on your behalf, please do not schedule anything until we can confirm our availability to meet. *We do not ship puppies without someone traveling with them at this time.
Do you agree to give us follow-up reports and photos from time to time? *
Do you agree to contact us in the case that you need to re-home this puppy for whatever reason? *
Getting a puppy is a lifelong commitment. Standard Poodles have an average life expectancy of 12+ years. We are always available to assist if you need to rehome your puppy, but certainly prefer that you will be their forever family.
Please list 2 references including their name, email, and phone number. 1 should be someone who knows of your experience/ interactions with animals. (Ie. groomer, vet, neighbor you dog sit for, etc.)
Please get permission from and let your references know that we may be contacting them regarding your future with a puppy.
Do you have any questions or other relevant information you’d like us to note?

Agreement
Please check the following that you have read and completed the application truthfully and to the best of your ability. *

I Agree
Please enter your full Legal name below as verification that all of the above information is complete and accurate. If approved and anything should change prior to the puppy pick up day, you agree to contact Derby Family Poodle to let them know.

You acknowledge that you will be held liable and legally responsible for everything stated in this application should it be found that you purposefully mislead Derby Family Poodle with the intent to obtain a puppy in a fraudulent manner.
Your Signature *

Clear
When you click submit, it will have you wait about 90 seconds to verify all of the content submitted. Sorry for the wait, but we want everything correct.
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform

Thank you for your interest in Derby Family Poodle puppies.