Puppy Raiser Application

KSDS Puppy Raiser Application
Name *

First Name Last Name
Age *
Guardian's name (if under 18)

First Name Last Name

Address *

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

Phone Number (cell) *

Area Code Phone Number
Phone Number (home/work)

Area Code Phone Number
E-mail *
Choose a breed preference *

Labrador Retriever Golden Retriever No Preference
Choose a preference *

Male Female No preference
Your Local News Media
How did you hear about KSDS Assistance Dogs, Inc.? *
Will this be a 4-H or scout project? *

Yes No
Home/Other Pet Questions
How many adults are in your home? *
How many children are in your home? *
Age of children
Do you have other dogs in your home? *

Yes No
If yes, please list:
Have they been spayed or neutered?
Are they house dogs or outside dogs? (Please note that all KSDS puppies must be raised as house dogs.)

House Dogs Outside Dogs
Do you have other animals? *

Yes No
If yes, please list:
Is your yard fenced in? *

Yes No
If no, do you have a dog friendly area nearby to exercise the puppy?
Other
Do you have experience in dog training? *

Yes No
If yes, please explain.
How many hours a day would the puppy be left alone? (A puppy in cape can gain access to public places including your work, with permission from employer.) *
When do you want to receive a puppy? *
Please tell us why you want to raise a KSDS puppy. *
What are your hobbies or other interest?
Please include pictures of the environment the puppy will be raised in; such as exercise area, your home environment and any additional photos you feel would be beneficial.
Upload pictures *

Browse Files

Cancel of
References

Please ensure you ask each reference mentioned below to submit a letter of reference on your behalf. We will not reach out to references unless we have a follow-up question on a reference we have already received.
Veterinarian that will be attending the puppy.
Name *

First Name Last Name

Address *

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

Phone Number *

Area Code Phone Number
Person outside the family such as 4-H leader, co-worker, etc.
Name *

First Name Last Name

Address *

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

Phone Number *

Area Code Phone Number
Terms and Conditions
All KSDS Assistance Dogs' puppy raisers must agree to the following conditions:
- To give the puppy a loving and secure home for 16-20 months (may vary)
- To train the puppy according to the KSDS training manual
- To socialize the puppy under normal supervised circumstances
- To send in monthly puppy reports and keep KSDS informed on progress
- To provide proper routine and emergency medical care for the puppy
- To return the puppy to KSDS for further training at the required time
Do you agree to the above terms and conditions? *

Yes No
KSDS Assistance Dogs, Inc. does not discriminate against any person on the basis of race, color, national origin, disability, sexual orientation or age in admission, treatment or participation in its programs, services and activities.
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KSDS Puppy Raiser Application

Home/Other Pet Questions

Other

References

Terms and Conditions