Survey - K9 Buddy Application - Guide Dogs for the Blind

Thank you for your interest in the K9 Buddy Program! Dogs available for adoption are purebred Labrador Retrievers (black and yellow), Golden Retrievers, and Labrador/Golden Retriever crossbreeds. Most are young adult dogs that are unsuitable to be Guide Dogs for medical or behavioral reasons, but would make excellent friends for youth. A few older retired guides or breeding stock may occasionally become available. Each dog is spayed or neutered, current on vaccinations and heart preventative. Dogs placed from our campuses have had hip and elbow x-rays and eye examinations. None of these dogs may be used as working guides for the visually impaired.

Guide Dogs for the Blind strives to match each individual dog with a home that meets the specific needs of both the dog and the adopter. Therefore, placement is not based on the length of time an application has been on file. The application is not transferable. There is no way to predict when an appropriate dog for you may become available. Filing an application does not guarantee receipt of a dog. We will contact you with further questions and to arrange for a home interview and program orientation. Applicants must be willing to participate in and complete a course of training. Permanent placement of K9 Buddy dog is contingent on progress and development between the family and K9 Buddy.

K9 Buddies are only placed in the eight Western states in the US, the same area we have puppies being raised and the staff to support these programs.

Please provide us with your information so we may process your application:

*

Name:

First Required	Last Required

*

Email: Required

*

Street 1: Required

*

City/State/ZIP:

City Required	State Required	ZIP Required

*

Phone Number: Required

*

Question - Required - K9 Buddy applicant name:

Question - Not Required - Date of birth:

Month

Day

Year

Question - Not Required - Grade:

Question - Not Required - Cause of visual impairment:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Visual acuity / visual fields:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Is the child legally blind? Yes
No

Question - Not Required - Do you own or rent your home? Own
Rent

Question - Not Required - If you rent, please provide landlord's name and phone number:

Question - Not Required - Is anyone in your household allergic to dogs? Yes
No

Question - Not Required - If other children under 18 live with you or visit often, what are their ages?

Question - Not Required - Besides the K9 Buddy applicant, are there other persons with special needs in your home? Yes
No

Question - Not Required - If yes, please describe:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Have you ever taken a dog through an obedience class? Yes
No

Question - Not Required - Are you able / willing to purchase and use a dog crate? Yes
No

Question - Not Required - What is the average number of hours per day the dog would spend alone (without people)?

Question - Not Required - Where would the dog be when alone? In House
Outdoors
In Garage
Other

Question - Not Required - Where would the dog be at night? In House
Outdoors
In Garage
Other

Question - Not Required - Do you have a securely fenced yard? Yes
No

Question - Not Required - If yes, how high is the fence?

Question - Not Required - Do you have an enclosed dog run? Yes
No

Question - Not Required - If yes, how high is the fence?

Question - Not Required - May a GDB representative visit your home to perform a fence check? Yes
No

Question - Not Required - May a GDB representative visit your home to perform an interview? Yes
No

Question - Not Required - Why do you want a K9 Buddy from Guide Dogs for the Blind?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Please list all dogs currently in your home and/or that you have had in the past. Include breed, age, and sex of each dog.

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Are all of the dogs currently in your home and/or that you have had in the past spayed/neutered? Yes
No

Question - Not Required - When were these dogs owned by you?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Are or were the dogs kept inside, kept outside, or both?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - What became of the dog(s)?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - How did you acquire your previous dog(s)?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - What other pets or livestock live at this residence?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - How did you hear about our program?

(Maximum response 255 chars, approx. 5 rows of text)

I understand that it is my responsibility to keep Guide Dogs for the Blind informed of changes in my address and phone number, as well as changes in my interest in adopting a K9 Buddy.

Question - Not Required - By checking 'Yes', I certify that I understand the information provided on this page and that the information I have provided above is correct. Yes
No

K9 Buddy Application

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