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Home
About
Our Dogs
Success Stories
How to Apply
- Eligibility & Application Process
- Service Dog Application
Ways to Help
Gallery
Contact

Home
About
Our Dogs
Success Stories
How to Apply
- Eligibility & Application Process
- Service Dog Application
Ways to Help
Gallery
Contact

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Home
About
Our Dogs
Success Stories
How to Apply
- Eligibility & Application Process
- Service Dog Application
Ways to Help
Gallery
Contact

Puppy Raiser Application

Name*
First Last
Address
Street Address City State ZIP Code
Home Phone*
Cell Phone
Work Phone
Email*
Is everyone in your household aware of your intentions of becoming a puppy raiser?
- Yes
- No
What age would you consider raising?
- Pre-School Puppy Raisers, (pups age: 8 weeks – 4 to 6 months)
- Elementary Puppy Raisers, (pups age: 4 months – 12 months)
- Junior Puppy Raisers, (pups age: 12 – 18 months)
- Advanced Puppy Raiser, (pups age: 18-24 months)
Select all that apply
Is anyone in your household allergic to pets?
- Yes
- No
Are there children in your household?
- Yes
- No
Ages
Separate ages with comma
Are the children familiar with animals?
- Yes
- Somewhat
- No
Do you have other pets at this time?
- Yes
- No
How Many?
If yes, please list all current pets (include breed and age):
Are all pets current on vaccinations, heartworm treatment and flea control?
- Yes
- No
If no, please explain
Where will the pet be kept during the day?
- Inside
- Outside
- Crated
Where will the pet be kept when no one is home?
- Inside
- Outside
- Crated
How many hours a day will the pet be left alone on average?
Do you have a fenced yard?
- Yes
- No
What type of fencing?
Who will be the primary caregiver?
First Last
Have you ever surrendered a pet to the humane society or animal care and control?
- Yes
- No
If yes, please give details
Do you own your home?
- Yes
- No
If renting, please list your landlord's name and phone number:
How did you hear about us?
Reason for wanting to be a puppy raiser, or additional comments you would like to make in regards to your application:
Each Puppy Raiser level has specific daily training commitments, weekly and/or bi-weekly commitments with the training staff, group training commitments and event commitments. These commitments are subject to change based on the needs of the pup and the organization.
Are you able to commit to a minimum of a half an hour of training the pup per day?
- Yes
- No
Are you able to commit to weekly lessons with the pup?
- Yes
- No
Are you able to commit to group training approximately every six weeks?
- Yes
- No
Are you able to commit to attending Genesis events as needed?
- Yes
- No
All Puppy Raiser levels are committed to appropriate socialization and generalization to public settings as directed by the training staff.
Are you able to commit to getting the pup out and about in the community as directed?
- Yes
- No
Are you able to take the pup to work with you?
- Yes
- No
Please check below*
- I CERTIFY THAT THE INFORMATION LISTED ABOVE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.
Date*

Genesis Assistance Dogs, Inc.

Mailing Address:
P.O. Box 3101, West Palm Beach, FL 33402
info@genesisassistancedogsinc.org
(561) 329-0277

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