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Puppy Raisers – Application
Puppy Raisers – Application
Puppy Raisers Application
* I am applying to be a puppy raiser:
Choose...
Full Time
Weekend
Both
* Your Name:
* Date
* Your Email
* Mailing Address
Home Phone
* Cell Phone
* Best Time To Reach You
* Drivers License Number
Select a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
* Employer/Business Name
* Work Address
* Work Phone Number
* Will you be able to bring your service dog to work with you?
Choose...
Yes
No
If yes, please tell us a little about your workplace and job.
* How many members are in your household? (Please put the number of Adults and the number of Children)
* Do you have a fenced in yard?
Choose...
Yes
No
* Where do you currently reside?
Choose...
House
Duplex
Apartment
Condo
Other
* What interests and/or hobbies would you be able to have your service dog participate in?
* How many dogs do you have currently?
* Age(s)
Sex
* Spayed/Neutered
Choose...
Yes
No
* Crate Trained?
Choose...
Yes
No
* Are your pets’ vaccinations current? (You will be asked to provide documentation.)
Choose...
Yes
No
* Does your dog alert bark or bark at people entering your home?
Choose...
Yes
No
If yes explain
* Does your dog have a history of fighting, biting or growling?
Choose...
Yes
No
If yes, please explain
* Does your dog have health issues?
Choose...
Yes
No
If yes, please explain
* Name of heartworm prevention
* Name of flea/tick prevention
* Do you have any cats?
Choose...
Yes
No
If yes, how many cats do you have
Age(s)
Sex
Name of flea/tick prevention
Previous experience with dogs:
Other Pets: Please list other pets below (all other pets must be caged at all times)
Current Veterinarian Name
Current Veterinarian Address
Current Veterinarian Phone Number
Do you have any previous puppy raising or dog training experience?
Choose...
Yes
No
If yes, please explain
Please describe any other dog experiences you’ve had, particularly any positive or negative:
Are you comfortable working a dog in a public setting?
Choose...
Yes
No
You will receive attention from the public while training a service dog? Will that be a problem?
Choose...
Yes
No
Can you commit to working with a dog for a period of several months (Sunday through Saturday)?
Choose...
Yes
No
Please provide us with any other information you find applicable.
How did you hear about Patriot PAWS Service Dogs?
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