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?*
Is this person employed or in school full time?*

YesNo
Where do they work or attend school?*
Will the puppy go with them?*

YesNo
If yes, how often?
Do you have written approval to bring the puppy?*

YesNo
What will the puppy do while you’re away?*
If the puppy stays home, is someone available every four hours?*

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)
Are your dogs leash trained?*

YesNo
Do they socialize well with others?*

YesNo

Time & Training Commitment
Can you walk the puppy twice daily (30 min each)?*

YesNo
Will you attend weekly obedience classes?*

YesNo
Can you spend an extra 30 minutes daily on training?*

YesNo
Can you bring the puppy into the community 3+ times/week?*

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 within 7 business days. 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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