Puppy-raising form

If you are interested in becoming a Mobility Dogs puppy-raiser, please fill out the form below and press 'Send'. Once your form is received, we will contact you to discuss your application and, if appropriate, arrange an interview. We meet in your home to assess your suitability, and answer any questions you may have regarding puppy-raising.

Please answer as many of the questions as possible.

Name

Address

Phone

Fax

EMPLOYMENT
Are you employed outside your home?	Yes No
If YES, please state the number of hours per day (Including travel time)
HOUSEHOLD
Members of your household, including their age and relationship to you:


Do you have a dog?	Yes No
If YES, is it castrated or spayed?	Yes No
What is its age?
What is its sex?	MF
What is its breed?
Do you have any other pets? If yes, please give details:

ESSENTIAL REQUIREMENTS
Do you own a car in which the puppy may travel?	Yes No
Is your section adequately fenced? (We require a minimum height of 5'6" and dog proof)	Yes No
Can you walk the puppy in town three times a week?	Yes No
Can you devote adequate time to walk, socialise and train the puppy?	Yes No
Are you aware of and prepared to cope with puppy behaviour such as digging and chewing?	Yes No

Please make a short comment on why you would like to become a puppy-raiser
for Mobility Dogs:

Any other comments you might like to make: