Apply to Raise a Puppy

Complete this application to apply to raise a Guide Dog puppy!

First Name *

Last Name *

Today's Date *

Month

Day

Year

Would you like to be a puppy raiser, breeder host or foster parent? *

Puppy RaiserBreeder HostFoster ParentCheck all that apply

Is applicant under the age of 18? *YesNo

Street Address *

Apartment, suite, etc *

City *

State *

ZIP / Postal Code *

Phone *

Would you like to provide an additional phone number? *YesNo

Secondary Phone *

Email Address

Would you like to add a secondary email address? *YesNo

Secondary Email Address *

Describe your home area

Prefix

First Name *

Last Name *

Are there children in the home?YesNo

Ages of children *

Where did you hear about our puppy raising program? *

Have you ever raised a dog before? *YesNo

Have you ever raised a future Guide Dog for someone who is blind or visually impaired? *YesNoAnother type of service dog

When and for which organization? *

What became of that dog? *

Do you have pets? *YesNo

Please give type, breed (if dog/s), and ages: *

Do you have a fenced yard or enclosed area to relieve the puppy? *YesNo

Do you agree to allow the puppy to live in your house and sleep in your bedroom?YesNo

Breed preference? *

Labrador RetrieverStandard PoodleNo Preference

Gender Preference? *

MaleFemaleNo preference

The puppy raiser is responsible for providing a loving atmosphere, socialization opportunities, and for teaching the puppy appropriate house behavior. The approximate cost to the raiser is $1,000.00. This cost is considered a donation and may be tax-deductible. We provide veterinary services withing 30 miles of our campus in Whitewater, CA. We have a reimbursement process for approved veterinary services such as emergency visits and normal veterinary expenses outside of the 30-mile radius.

Checking the box next to each statement below signifies your acknowledgement and agreement with these statements.

What date are you available to receive a puppy? (usually there is a 6 month wait) *

References

Reference 1

Name *

Street Address *

Apartment, suite, etc

City *

State *

ZIP / Postal Code *

Country *

Email Address *

Phone *

Relationship *

Reference 2

Name *

Street Address *

Apartment, suite, etc

City *

State *

ZIP / Postal Code *

Country *

Email Address *

Phone *

Relationship *

If you live anywhere that requires a pet deposit such as an apartment, track homes, rental agreement, can you provide approval from property management? *YesNo

If you plan to take the pet to work with you, can you provide approval from your supervisor? *YesNo

If you have any documentation supporting these permissions available to upload now, please do so here.

If you do not have them available yet, you can email them to use. Please note that application will not be considered completed without these materials.

Please type applicant's full name *Typing my name in the form above acknowledges that I have read and understood the information included in this application- and that al information is accurate to the best of my knowledge.

Please type full name of parent or guardian *Typing my name in the form above acknowledges that I have read and understood the information included in this application- and that al information is accurate to the best of my knowledge.

$10 – Can provide a Kong toy for a developing Guide Dog in Training
$15 – Can provide a training leash for a future Guide Dog
$100 – Helps provide shampoo and grooming supplies for the dogs on Campus during their training
$250 – Helps provide toys and bowls for the dogs on Campus during their training
$500 – Helps feed our dogs for one month
$750 – Helps provide necessary equipment (leashes and harnesses) for our dogs during their training
$1,000 – Helps provide medical services for our dogs during their journey to becoming a Guide Dog
$2,500 – Helps provide newborn care for a litter of puppies
$3,000 – Helps provide Room and Board for our students attending In-Residence Training