Puppy Raising Expression of Interest Form
(To be a puppy raiser you must be over the age of 18.)
Are you over 18 years of age?
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Yes
No
You must be over 18
I understand
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Apply
First and Last Name:
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Street Address
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City:
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State:
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Postcode:
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Mobile phone:
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Email Address:
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How did you hear about Mobility Dog puppy raising?
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Mobility Dogs website
Email from Mobility Dogs
From a friend or family member
Social media
From a fundraising campaign
What motivated you to apply to become a puppy raiser for Mobility Dogs?
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How would you describe your experience and confidence around large dogs?
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Please Select
Very confident
Confident
Somewhat confident
Not confident
Are you willing to learn and follow Mobility Dogs’ training guidelines?
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Please Select
Yes
No
How long do you think you will be available to puppy raise for?
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Please Select
Between 3 - 6 months
More than 6 months
Labradors and Golden Retrievers grow into medium to large sized dogs, are you physically capable of handling a dog between 10-40kgs?
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Please Select
Yes
No
Do you have any allergies, medical or psychological conditions that may prevent you from working with dogs?
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Please Select
Yes
No
If you answered yes to the above question; please can you give us more information?
Is your house or flat fully fenced?
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Please Select
Yes
No
If you are renting, is your landlord agreeable to letting you have a dog? You will need to provide us with written permission.
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Please Select
Yes
No
I need to check
Are you available for at least one group training session during the week?
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Please Select
Yes
No
Are you working more than 20 hours a week?
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Please Select
Yes
No
Do you have any additional comments or concerns you would like us to know about?
Mobility Dogs will keep your information confidential, as outlined in our privacy statement on our website www.mobilitydogs.co.nz/privacy-policy.
Apply
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