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Weekend Raiser Application Form
Yes! I want to become a Weekend Puppy Raiser and help a puppy become an assistance dog!
Required fields are listed with a "*" next to them.
*Prefix (ex. Mr., Mrs. Ms.)
*First Name
*Last Name
*Email Address:
Permanent Home/Family Address
*Address Line 1
Address Line 2
*City
State
Zip Code
*Phone (Day)
Best time to reach you
*
Phone (Night)
Best time to reach you
*Are you at least 18 years of age?
No
Yes
If you have children, what are their ages?
*How many people are in your household?
*Which person will assume primary responsibility for the care of the puppy?
*Does the primary caretaker work full-time/part-time? How many hours per week?
*Have you raised a puppy in the past?
No
Yes
Other Pets
Do you currently have any pets at home?
No
Yes
If yes, what kind(s)?
If "yes" to cats, how does each cat react to dog(s) in the home?
Do you have a dog at home?
No
Yes
If "yes" to dogs, what are the ages, and are they male, female, neutered or spayed?
If "yes" to dogs, how does it react to other animals? Please specify.
Do you have a fenced-in yard?
No
Yes
If so, what height?
If yes, what kind of fence?
*Is your family willing to absorb the cost of feeding a puppy our specified diet (food cost is estimated at $30 per month) including toys?
No
Yes
Which prison puppy program facility are you interested in?
Blackwater River Correctional Facility - Milton, FL
MacDougal Walker - Suffield, CT
Maine State Prison - Warren, ME
MCI & MCTC Hagerstown - Hagerstown, MD
MCI Framingham - Framingham, MA
MCI Shirley - Shirley, MA
MCI-W Jessup - Jessup, MD
Old Colony Correctional Center - Bridgewater, MA
Osborn Correctional Institution - Somers, CT
Pondville Correctional Center - Norfolk, MA
SCI Dallas - Dallas, PA
SMCC Framingham - Framingham, MA
Western Correctional Institution - Cumberland, MD
Comments/Notes
Where did you hear about the program?
America's VetDogs Webpage
Facebook
Guide Dog Foundation Webpage
Heard ad on radio station
I already volunteer here/GDF staff (different department)
Instagram
Internet Search
Referred by a Puppy Raiser
Referred by friend who is not a puppy raiser
Saw a live presentation about puppy raising
Saw ad or story in print media
Saw flyer/poster at local business
Saw video/read news online
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