NEADS Breeder Caretaker Interest Form

First Name

Last Name

Phone

Is this Mobile/Cell or Home?

Mobile/CellHome

Address

City

State

Zip Code

I have owned all of my personal pets (dogs and cats) for more than 1 year

YesNo

All of my personal pet dogs are spayed/neutered.

YesNo

I understand and agree to the following requirements for the Breeder Caretaker Program:

I will be responsible for transporting the dog to and from NEADS as needed for the program (5-10 times per year)I meet the distance requirements for this program (live within 75 miles for brood caretaker or 45 miles for a stud caretaker)All members of the household involved in the care of the dog will attend a pre-placement class