Application

NEADS Puppy Raiser

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  = Required Information

Personal Information

First Name
Last name
Street Address
City
State
Postal Code
Phone Number
Mobile Phone
Email
How many members in your household?
# of Adults
# of Children
Children's Ages
What is the best time to contact you and how?
In case of emergency, name of a relative we can call if we could not reach you.
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Phone
Emergency Contact Relationship
Are you willing to provide your date of birth for your department of corrections background check?
Birthdate
Birth Month
Birth Day
Birth Year

Professional Activities

PLEASE NOTE, THE RESPONSIBLE PARTY FOR THE PUP MUST BE AT LEAST 25 YEARS OF AGE, AND HANDLERS MUST BE AT LEAST 18 YEARS OLD.
Do you have an occupation?
Do you feel you can handle a young dog in training in addition to your everyday responsibilities?

Current Pets

Do you understand that the NEADS dog in training will only be allowed very little interaction with your pet dog and are you willing to manage this carefully?
All pet dogs must be spayed/neutered.
Do you have dogs?
Do you have cats or other pets?
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