Assistance Dog Puppy Prospect
EOI Early Learning Puppy Program
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Owner lives in?
House
Unit
Acreage
Other
Do you own or rent?
Are you permitted to have dogs at your residence?
How many people, dog and other animals live in the house? What ages? Types? Please describe each person and animal within the household.
Are you employed? Please outline your work history if relevant.
Are all animals within your household up to date with vaccinations?
What experience have you had raising and training animals, in particular dogs / puppies?
Have you had an Assistance Dog before? If so, Please provide details
Do you have a diagnosed disability? Please provide diagnosis (details are not needed).
How many hours a day are you able to commit to caring for your puppy?
Puppies are hard work, can test boundaries and patience, are you able to deal with stressful situations or have plans in place to cope?
Are you an NDIS participant? If so, does your plan support an Assistance Dog AND Community Participation?
Have you applied for an assistance dog with any other agency?
Are you aware that the puppy comes home to you at 8 weeks of age? Do you have the finances to commit to training the puppy? House the puppy and feed the puppy?
An Assistance Dog is trained to alleviate a persons disability. How would you benefit from an Assistance Dog and what would you like the dog to do to help your disability? Both at home and in public.
Do you intend to participate in the Early Learning Puppy Program? If not, why? DO you have another dog trainer to assist in training your dog, if so who? Please note... you do not need to participate in our Early Learning Puppy Program to qualify but you do need to have an arrangement in place with another trainer to sufficiently train the puppy.
Tell me about yourself.
Why should you be considered for one of our puppies?
Is there anything else you wish to tell us about you, your life, your home anything really?
Want to chat in person? Please book in an appointment time below.
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