Nomination Form
Only Active Duty Military, Veterans, or First Responders may be nominated
Nominee Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
The Nominee is:
*
Active Duty Military
Veteran
First Responder
If Military, what branch? If First Responder, what type?
*
Is this nomination for yourself or someone else?
*
Someone else
Myself
If this nomination is for someone else, please explain how you know them:
If this nomination is for someone else, do they know you are nominating them?
Yes
No
This nomination is for me
If this nomination is for someone else, please fill in your Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If your nomination is for someone else, please fill in your Phone Number
Please tell us a little about the Nominee (including age, service work, any recognition for outstanding service, etc) & explain why you believe the Nominee would benefit from a Working K9:
*
Please specify what tasks the K9 may need to be trained to do:
*
Does the Nominee have other animals?
*
Yes
No
I am unsure
What size K9 would you recommend for the Nominee?
*
Small
Medium
Large
Does Not Matter
Please list 2 references for the Nominee that can validate their need for a Working K9:
*
Full Name
Relationship to Nominee
Contact Number
1
2
How did you hear about us?
*
Please Select
Referral
Social Media
Website
Other
How do you prefer to be contacted? (Select all that apply)
*
Phone Call
Text
Email
How should the Nominee be initially contacted? (Select all that apply)
*
Phone Call
Text
Email
By signing this Nomination Form:
I confirm that the information I provided is true to the best of my knowledge. I confirm that this Nominee is one of the following: Active Duty Military, First Responder, or a Veteran. I understand there may be costs associated with the donated K9 and agree to insure those costs are covered. I understand that only ONE Nominee will be selected per year, at this time, and that the decision is solely at the discretion of RDK9. I agree to not retaliate against RDK9 if my Nominee is not chosen to receive the Working K9. I understand that my Nominee, if not chosen, will still have the opportunity to formally adopt another K9 through RDK9, however, there will be costs associated with an official adoption. I understand that if selected, the Nominee will be required to fill out the standard adoption application for RDK9. *Please Note: RDK9 generally specializes in Belgian Malinois & German Shepherds, therefore, the Nominee must have experience with either of these breeds or be willing to attend training sessions if selected. If the Nominee selected prefers a different breed, please note that there may be costs associated with securing the breed of choice, as the K9 must be from a shelter, and the costs will be the responsibility of you or the Nominee. If a K9 is selected from a shelter, RDK9 offers no guarantees regarding same & the Nominee will be responsible for same once the rescue tag is sent.
Signature
*
Please upload a photo of the Nominee (if selected, the photo will be used in the announcement)
Submit
Should be Empty: