Are you interested in becoming a:
Puppy RaiserTraining Dog Carer

Personal Details

Name (required)

Address (required)

Email (required)

Telephone (required)

Household Details

Number of Household Members (required)

Are there any children in your household (required)
YesNo

Please list ages (separate with commas)

Residential Details

Type of Residence (required)
HouseTownhouseDuplex HouseApartment BuildingOther
If Other specify below

Where will the puppy sleep? (required)
InsideOutside

Please select the appropriate option regarding your yard (required)
Fully FencedLarge PropertyNo Yard

Other Pet Details

Do you have any pets at home? (required)
YesNo

Pet #1

Species
Breed
Age
Sex
Desexed YesNo

Pet #2

Species
Breed
Age
Sex
Desexed YesNo

Pet #3

Species
Breed
Age
Sex
Desexed YesNo

Employment Details

Name of Company

Address

Employment Status: Full-TimePart-TimeCasual
Will the dog be allowed at work with you? YesNo
Have you discussed this with your employer? YesNo
How long would it be left at home alone? Never1 hour2 hours3 hoursMore than 4 hours
How frequently would it be left at home alone? Once a weekTwice a weekThree or more times a week
Are you able to attend visits with the trainer within office hours? YesNo

Other Details

Prior experiences in puppy raising:

Reasons for wanting to raise a puppy:

How did you hear about the program:

Thank you for taking the time to fill this application. We will endeavour to contact you within 48 hours regarding your application