Puppy Raiser Application

Full Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone *

Cell Phone

E-mail *

Age *

Marital Status *

Gender *

Do you live in: *

Please Specify:

Please list ALL family and household members.

Your Employer

Position

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

How many puppies have you raised?

How many dogs currently reside in your home?

Do any other animals reside in your home?

eg: Cats

Have You Been a Puppy Raiser Before *

Yes No

If yes, with which organization?

Do you have a preference in breed, gender, or color? *

Yes No

If yes, please explain

Do you have a secure enclosed yard? *

Yes No

If NO, please explain

Are you willing and able to take this puppy (16 weeks of age or older) to work or school with you every day? *

Yes No

On occasion NADI will need puppies for demonstrations, fund raising activities or other public events. Are you willing to either attend these activities or relinquish the puppy for the day? *

Yes No

NADI does most communication through email. Are you willing/able to check email on a daily basis and respond to our emails? *

Yes No

If accepted as a puppy raiser:

I/we agree that household members who have contact with the puppy agree to NADI rules and regulations.