Puppy Raiser Application Form
Personal Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Email
*
example@example.com
Back
Next
Save
Residential Information
Number of people living at your residence ?
*
Housing Situation
*
Renting
Own
Do you have permission to have a dog at your residence ?
*
Yes
No
Are there any children living ay the residence ?
*
Yes
No
Number of children living at residence ?
*
Ages of children living at residence ?
*
Type of residence ?
*
Example: House, Apartment, Average
Size of yard approximately ?
*
Type of fencing ?
*
Back
Next
Save
Additional Pet Information
Current pets/ animals on property. Please indicate all animals. If you have dog/s under the training heading please list if they have received any professional training - at what age, and the name of the trainer or training organisation.
Animals on Property
*
Rows
Type of Animal
Desexed
Vaccinated
Indoor/Outdoor
Training
Animal 1
Yes
No
Yes
No
Indoor
Outdoor
Both
Animal 2
Yes
No
Yes
No
Indoor
Outdoor
Both
Animal 3
Yes
No
Yes
No
Indoor
Outdoor
Both
Animal 4
Yes
No
Yes
No
Indoor
Outdoor
Both
Animal 5
Yes
No
Yes
No
Indoor
Outdoor
Both
Animal 6
Yes
No
Yes
No
Indoor
Outdoor
Both
Please list any additional pets that aren't listed above. Please answer all questions asked above.
Back
Next
Save
Employment Information
Are you currently employed or working
*
Yes
No
Company you work for ?
Company Address ?
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employment Status ?
Example: Part-time, Full-Time, Casual
Will the dog be allowed to go to work with you ?
Yes
No
Have you discussed this with your employer ?
Yes
No
How long will it be left at home alone ?
*
How frequently would it be left at home alone ?
*
Are you able to attend visits with the trainer within office hours ?
*
Yes
No
Have you had any experience as a puppy raiser ?
*
Yes
No
Reasons for wanting to raise a puppy ?
*
How did you hear about the program ?
*
Thank you for applying to be a puppy raiser. We will endeavour to get back to you as soon as possible with regards to the outcome of your application.
Save
Submit
Should be Empty: