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Puppy Raising application form

Section A

Title

First Name *

Last Name *

Email Address

Phone (home) *

Phone (work)

Phone (mobile)

Street address *

Suburb *

State

Post code *

1. How did you hear about Puppy Raising?

2. Why do you want to Puppy Raise?

3. Is everyone in the household keen to Puppy Raise?
YesNo

4. Household members (number and ages of residents)

5. Have you had a dog before?
YesNo

6. Do you have a dog now?
YesNo

7. Have you ever attended any dog obedience classes?
YesNo

8. Do you have any other pets?
YesNo

9. Do any adjoining properties have dogs?
YesNo

* 10. Does your property have dog proof fencing?
YesNo

Section B

* These questions cover minimum requirements in caring for a Guide Dog puppy.

We will be in contact to let you know the outcome of your application.