Puppy Raiser Application Puppy Raiser Application Puppy Raiser Application First Name * Last Name * Upload a picture of yourself Drop a file here or click to upload Choose File Maximum upload size: 10MB Email * Phone * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Emergency Contact Name * Emergency Contact Phone Number * Do you own your home or rent? Select an option Own Rent Will you have your landlord's support? Select an option Yes No Do you have a fenced yard? Select an option Yes No What motivated you to apply to become a puppy raiser? Please explain. Are you willing to commit to housing, training, and feeding a puppy for a year? * Select an option Yes No How do you think you and your family will feel about rehoming the puppy to Amazing Tails after raising him/her for a year? Are you willing and able to travel to Amazing Tails at least two weekdays per month for puppy training classes as well as providing a monthly report via our website? * Yes No Have you ever owned a dog? * Yes No Please tell us about your dog(s) What sort of training did/do you do with your dog(s) Is anyone in your family allergic to dogs? * Yes No How did you hear about Amazing Tails? * Are you willing to walk your puppy several times a day? * Yes No Living Situation Who lives with you - Relationship I live alone Friend Family Member Roommate Other Who lives with you - Relationship Age Add Remove Are you employed? * Yes No Employment Details Name of Employer * Employer Phone Number * Employer Email * Management Contact Name * Is your employer supportive of you bringing a puppy to work? * Option 1 Address of Employer * Address of Employer Address of Employer Address of Employer City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Do you work outside the home? * Yes No What places do you foresee taking the puppy? * What experiences can you offer a growing puppy? * How do you think you and your family can contribute to the Puppy Raiser Program? * What qualities do you feel you have that will make you a good puppy raiser? * Is there anything else that you would like to share with us? If you are human, leave this field blank. Submit Δ
