Puppy Raiser Application
PRIMARY INFORMATION
*Name of Primary Caregiver:
*Home Phone:
Cell Phone:
Business Phone:
*Home Address:
*City:
*Province:
*Postal Code:
*Email Address:
*Date:
Applicants must attend mandatory obedience classes at National Service Dogs
Training Centre in Cambridge, Ontario or at an NSD approved training centre.
OCCUPATION/SKILLS/INTERESTS
*Occupation of Main Caregiver:
*Hobbies, Skills:
*Previous Volunteer Work:
If you are a student, please provide name and phone number of both parents
as well as the name of the institution you are registered as a student.
STUDENT INFORMATION
Parent's Names:
Parent's Home Phone:
Parent's Work Phone:
Institution/School Name:
DOG INFORMATION
*Have you now, or have you in the past, ever owned a dog?
Yes No
If so, what breed?
*Are you allergic to dogs?
Yes No
*Are you comfortable with dogs?
Yes No
*Do you consider yourself knowledgeable in dog care and behaviour?
Yes No
If not are you willing to learn?
Yes No
*Are you aware that raising a future guide dog means approximately 1-3 hours per day should be devoted to handling, loving, feeding, grooming, toilet ting and training the puppy?
Yes No
*Is the puppy able to go to work with you?
Yes No
If so, describe the environment that the puppy would be in at work with you?
*If the puppy cannot accompany you to work is there someone able to relieve and exercise the puppy part way through the day? (The puppy cannot be left alone for more than 4 hours at a time)
 Yes No
*Are you aware that this is an 8-14 month commitment?
Yes No
*Why are you interested in raising a puppy for National Service Dogs?
DESCRIBE YOUR HOME ENVIRONMENT
*Where will the puppy be raised?
*Select the amount of traffic in your neighbourhood:
*What type of home do you live in?
*Are you a tenant?
Yes No
*Do you have a fenced yard?
Yes No
*How many other people live in your home?
*What are their ages?
YOUR EXPECTATIONS WHILE RAISING A PUPPY FOR NATIONAL SERVICE DOGS:
*What are your expectations?
*Will you be able to attend weekly puppy training classes?
Yes No
*Will you be able to take your puppy out into public for socialization at least 3 times a week? (This means socializing the puppy in malls, restaurants, schools, around other dogs, cats, people, traffic noises, heights, bridges, balconies, and other public venues)
Yes No
REFERENCES
*How did you hear about National Service Dogs?
Please forward to National Service Dogs 2 letters of reference (PO Box 28009 Preston Postal Outlet, Cambridge, ON N3H 5N4). Please include a letter of reference from your veterinarian (If no vet history a letter from a friend/relative) and a professional letter of reference (a letter from someone you work with).
~All fields marked with * are required!~