Puppy Raiser Application

Puppy Raiser Application

Puppy Raiser Application
Full Name*
First and last name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Primary Phone*

Area CodePhone Number

Household Information
List all household members and their ages*
Who will be primarily responsible for the puppy?*
YesNo
Where do they work or attend school?*
YesNo
If yes, how often?
YesNo
What will the puppy do while you’re away?*
YesNo
What’s the longest the puppy will be left alone?*
If you travel, what care arrangements can you make?*

Other Pets
Do you have dogs the puppy will interact with?*
(Include name, age, and breed)
YesNo
YesNo

Time & Training Commitment
YesNo
YesNo
YesNo
YesNo

Heading
Why do you want to be a Puppy Raiser?*
How do you feel about returning the puppy at the end of the program?*
What concerns do you have about the experience?*

References

(Provide 3 references)
Reference #1*
Reference #2*
Reference #3*

Final Confirmation
Type Full Name*
How did you hear about Canines for Change?*
I certify that the above information is complete and correct, and that I am at least 21 years of age. I understand that misrepresentation may disqualify me from the program.
Signature:*

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Date:*

MonthDayYear
Date
Thank you for taking the time to complete this application!

Our team will review it and reach out soon. We appreciate your interest and look forward to connecting with you soon!

If you’d like more information about the process in the meantime, please visit our website.
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