(All information contained in this application is confidential)

Applicant Information  *Some Fields are REQUIRED*
Name(s): A Name is required.Invalid format. Date:
A Date is required.
mm/dd/yy
Street/PO Box:
An Address is required.Invalid format.
City: , CO
A City is required.		 Zip:
A Zip is required.Invalid format.
Home#:
A value is required.		  
Cell#:
A value is required.		  
Work#:
A value is required.		  
Email:
An Email is required.Invalid format.		  
     
Emergency Contact Information *All Fields are REQUIRED*
Name:
A Name is required.Invalid format.		 Relationship:
The Relationship is required.Invalid format.
Home#: A value is required. Work#:
A value is required.
Cell#: A value is required.    
 
I am applying to be a:
All Applicants Must Answer 1-18

1. How did you hear about CaPR?
A value is required.

2. Why do you want to raise a puppy or be a puppy sitter for CaPR?
A value is required.

3. Have you ever raised a puppy or had an adult dog before?
   Please make a selection.

4. Do you have previous experience in dog training?
 Please make a selection.
If yes, please describe:

Are you familiar with “clicker training”?  Please make a selection.

5. Do you have an enclosed yard?  Please make a selection.

6. Is there a weight limitation for dogs where you live?  Please make a selection.

7. Are there children residing in your home?  Please make a selection.
If yes, what are their names and ages:


8. Are there animals living in your home?    Please make a selection.
If yes, please describe:



9. Are your pets currently vaccinated?  Please make a selection.

If you currently have a relationship with a veterinarian, please provide the following information:
Vet's Name:  
Street/PO Box: City: Zip:
Phone#: Fax#:

10. If you work outside the home, are you able to take a CaPR puppy to work with you?
 Please make a selection.

11. If you attend school, are you able to take a CaPR puppy to school with you?
 Please make a selection.

12. Are you willing to allow a puppy/dog to sleep (in a crate) in your bedroom?
 Please make a selection.

13. Are you willing to socialize a CaPR puppy in public (i.e. trips to grocery stores, malls, restaurants, movie theaters, other businesses)?
 Please make a selection.

14. Are you or another member of your household home during the daytime?
 Please make a selection.
If yes, who is home and for how many hours?


15. Describe any experience you have working with people with disabilities?


16. Please describe a typical day for you:
A value is required.

17. Are you willing to attend Puppy Classes and outings in the Denver metro area?
 Please make a selection.


Only Puppy Raiser applicants complete 19 - 21

18. Are you willing to make a 16-18 month commitment to the physical, emotional, financial, and training needs of a CaPR puppy/dog?
 Please make a selection.

19. Please describe your feelings about returning the puppy to CaPR for advanced training and then placement with a person with a disability.
A value is required.

20. If your application is approved, when will you be available to receive a puppy?
A value is required.


21. Please add any other information you would like us to consider.



Please check the following:
The above information is true and accurate Please make a selection.

As a CaPR puppy raiser, I agree to adhere to all requirements of Canine Partners of the Rockies, Inc. and to be responsible for the care, feeding and training of the CaPR puppy Please make a selection.

I agree to attend regularly scheduled puppy classes Please make a selection.

I confirm that the puppy is the property of CaPR and agree to return the puppy to CaPR upon request Please make a selection.