Patriot PAWS Puppy Preschool Application

Puppy Raiser/Sitter Requirements

At least 18-years-old to be primary handler; under 18 may assist a legal guardian.
Understanding that this is a family/household commitment, and everyone in the family/household needs to be involved in the welfare of the dog.
There shall be no more than 2 personal dogs per household (Patriot PAWS dog would equal 3 dogs in the home).
Permission from landlord for dog to reside in rental unit.
Allow a Puppy Raiser Coordinator to perform a home check.
Attend a Patriot PAWS volunteer orientation.
Attend training classes.
Follow the training guidelines given by Patriot PAWS.
Teach the dog good house manners.
Return the dog to the Rockwall campus as instructed by the trainers for movement or veterinary care.
Attend weekly check-ins (virtual or in person).

Personal Information

Date (mm/dd/yyyy):

Name (First Last)

DOB (mm/dd/yyyy)

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Email Address

Preferred Method of Contact

Emergency Contact

Phone Number

Relationship

Home Life

Where do you currently reside?

Do you have a fenced in yard?

If no yard, explain relief location and area for exercise:

If you rent, have you already received approval from your land lord?

Please list anyone living in your same residence (name, gender, age, relationship):

Other than children in your home, will your dog be exposed to children on a regular basis? If yes, please explain:

Does your entire household support this project? If no please explain your/their concerns (ex. preferences in type of dog, worries about energy or house training):

Describe your typical week:

How many hours a day would your dog need to be left alone in your house?

Do you expect any major changes in your life within the next year? If yes, please explain (ex. additional family moving in, new pets, a move):

Please check your typical availability for classes, outings, and other requirements:

Please list any current pets (species, breed, age, gender, spayed/neutered):

Are you already established with a veterinarian? If yes, please provide the clinic name:

Clinic Location (city)

Clinic Phone Number

Experience/Training

Do you have any experience with puppy raising or dog training? If yes, please explain:

Please describe any other dog experience you have:

Can you commit to working with a dog daily for an extended period of time?

How did you hear about Patriot PAWS Service Dogs?

Please provide us with any other information you find applicable:

Disclaimer

I understand that puppy raising is a major responsibility and if I do not meet and maintain my handler requirements, I will be removed from the Approved Handler list and must contact my Puppy Raiser Coordinator for instructions before returning to raising.

I understand that dogs will be in training and may be a young age when they enter my home. I understand that house manners work is part of our responsibility as a raiser. I will not hold Patriot PAWS responsible for damage to my property, ex. chewing or potty accidents.

I understand that these dogs are not “mine,” but rather are meant for a greater purpose. Therefore, I agree to follow the training guidelines put forth by the Patriot PAWS training staff. I also agree to return the Patriot PAWS dog when instructed, which may require me to transport the dog back to the Patriot PAWS Rockwall campus.

I hereby certify that the information provided in this form is true, complete, and accurate to the best of my knowledge and belief. By initialing below, I acknowledge that I have read and understood the foregoing and agree to the terms and conditions set forth herein.

Initials

Date (mm/dd/yyyy)

Media Release

Patriot PAWS Service Dogs periodically uses forms of media (i.e., photography, video, audio, footage, testimonials) for publicity, social media (Facebook, Twitter, Instagram, YouTube, Tik Tok, LinkedIn) and/or educational purposes. By signing, I acknowledge that I have received this document and give permission to Patriot PAWS Service Dogs to use my likeness (including first name, pictures, and video) in the above forms of media.

E-Signature

Date (mm/dd/yyyy)

I understand that I have the right to revoke this authorization at any time, and it must be submitted in writing to the Compliance Officer at:

Terri Stringer/HIPAA Compliance Officer

Patriot PAWS Service Dogs

254 Ranch Trail

Rockwall, TX 75032

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