Puppy Raiser

National Assistance Dogs, inc.

10235 N. 55th PL.

Paradise Valley, AZ 85253

Phone 480-251-9513

Full Name *

First Name Last Name

Address *

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

Phone *

- Area Code Phone Number

Cell Phone *

- Area Code Phone Number

E-mail *

Age *

Sex *

Marital Status *

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?

What other animals reside in your home?

Have you been a puppy raiser before? *

If yes, with which organization?

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

If yes, please explain

Do you have a secure enclosed yard? *

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? *

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? *

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

If accepted as a puppy raiser:

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

Signature

Clear

PUPPY RAISER APPLICATION