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Puppy Raisers – Application

Puppy Raisers Application

* I am applying to be a puppy raiser:

* Your Name:

* Date

* Your Email

* Mailing Address

Home Phone

* Cell Phone

* Best Time To Reach You

* Drivers License Number

Select a State

* Employer/Business Name

* Work Address

* Work Phone Number

* Will you be able to bring your service dog to work with you?

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?

* Where do you currently reside?

* 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

* Crate Trained?

* Are your pets’ vaccinations current? (You will be asked to provide documentation.)

* Does your dog alert bark or bark at people entering your home?

If yes explain

* Does your dog have a history of fighting, biting or growling?

If yes, please explain

* Does your dog have health issues?

If yes, please explain

* Name of heartworm prevention

* Name of flea/tick prevention

* Do you have any cats?

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?

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?

You will receive attention from the public while training a service dog? Will that be a problem?

Can you commit to working with a dog for a period of several months (Sunday through Saturday)?

Please provide us with any other information you find applicable.

How did you hear about Patriot PAWS Service Dogs?

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Puppy Raisers – Application

Puppy Raisers Application

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