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Puppy Raiser Application
Puppy Raiser Application
We would love to hear from you! Please fill out this form and we will get in touch with you shortly.
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Email
*
Phone
*
Is everyone in your house excited about raising an Independence guide dog?
*
Yes
No
Please list the names and ages of all family members.
*
Are any family members allergic to dogs?
*
Yes
No
Have you ever obedience trained a dog before?
*
Yes
No
If yes, what breed?
*
Have you ever raised a dog before?
*
Yes
No
If yes, what breed?
*
Do you have other dogs?
*
Yes
No
If yes, please list breed, age, sex, and if spayed/neutered.
*
How do they react to people?
*
How do they react to other dogs?
*
Are they house dogs or outdoor dogs?
*
House
Outdoor
*Note: Independence Guide Dog puppies must be raised as house dogs.
What type of area do you live in?
*
Rural
City
Residential
Do you have other animals?
*
Yes
No
If yes, what type?
*
How many hours a day will the puppy be left alone?
*
Are there sidewalks near your home?
*
Yes
No
Are you prepared to cover the cost of food for the puppy?
*
Yes
No
Are you able to provide daily exercise for the puppy?
*
Yes
No
Are you willing to socialize the puppy on a regular basis providing it exposure to people, sidewalks, and as they develop stores, restaurants and busy town areas?
*
Yes
No
When would you like to begin raising the puppy?
*
Do you have a preference of a male or female puppy?
*
Yes
No
If yes, which is your preference and why?
*
Please provide any additional comments you may have:
By submitting this application, I certify that I have reviewed the general information about raising an Independence Guide Dog puppy and I understand the commitment of time, money and love required to raise a pup.
*
Yes, I certify
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