|
First name* |
|
|
Last name* |
|
|
Street address or PO box |
|
|
Apartment or suite number |
|
|
City |
|
|
State |
|
|
Zip code |
|
|
Home phone |
|
|
Work phone |
|
|
Fax phone |
|
|
Cell phone |
|
|
E-mail address* |
|
|
Please list the guide dog puppies you have raised |
|
|
Do you understand it is a year commitment as a volunteer |
yes no |
|
Do you agreed to attend all the mandatory meetings with this puppy, or arrange for the puppy to be at all the mandatory meetings |
yes no |
|
If you have pets, please give the type, sex and ages of all pets: |
|
|
What hours are projected that the puppy will be home alone |
|
|
Will the puppy be allowed to sleep in your bedroom in a tie down or in a kennel crate |
yes no |
|
If not, where |
|
|
Do you agree to return the puppy to Southeastern Guide Dogs, Inc. when the puppy is called back to Southeastern Guide Dogs |
yes no |
|
What was the name of your last assigned veterinary clinic? |
|
Upon returning this application to Southeastern Guide Dogs, you can expect to receive a response within three to four weeks. You will be called for an in-home visit by an Area Coordinator.
If your application is approved, your name will be placed on a waiting list and you will be notified as soon as a puppy is available. Many times puppies are transported in groups geographically. A puppy would be placed in your care when a grouping is scheduled to be placed in your area. |
|
Comments or Questions: |
|
|
|
