Survey - Breeding Stock Volunteer Application

Your contact information:

*

Name:

First Required	Last Required

*

Email: Required

Street 1:

City/State/ZIP:

City	State	ZIP

Phone Number:

If you respond and have not already registered, you will receive periodic updates and communications from Guide Dogs for the Blind.

Remember me. What's this?

Please provide the following phone numbers:

Question - Not Required - Home:

Question - Not Required - Cell:

Question - Not Required - Work:

Question - Not Required - Please list the name of all Household members (and if children, their ages):

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

Question - Not Required - How did you hear about the breeding program?

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

Question - Not Required - Why do you want a breeding stock dog from Guide Dogs?

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

Question - Not Required - Please describe any previous involvement with Guide Dogs.

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

Question - Not Required - Do you own your home? Yes
No

Question - Not Required - If no, please provide landlord's name and phone number:

Question - Not Required - Length of time at this address:

Question - Not Required - GDB requires a minimum of a 5-foot secure fence (6-foot fence recommended) or an approved dog run for our breeding stock dogs. Please describe your fence and yard.

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

Question - Not Required - Does your property contain an in-ground swimming pool? Yes
No

Question - Not Required - If yes, is the pool separately fenced? Yes
No

Question - Not Required - If your property contains an in-ground swimming pool, does the pool have a child safety cover? Yes
No

Question - Not Required - Briefly describe a typical day in your household. How long will the dog be home alone each day?

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

Question - Not Required - Breeding stock dogs spend several weeks each year in our kennel. Does this present a difficulty for you or your family members?

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

Question - Not Required - Are you able to provide transportation of the dog to and from San Rafael whenever asked and in a timely manner between the hours of 8 a.m. and 5 p.m. seven days a week? (A brood bitch may require 8 to 10 round trips per year and a stud dog as many as 15.) Yes
No

Question - Not Required - Where will the dog sleep? Indoors
Outdoors

Question - Not Required - Specifically where?

Question - Not Required - Do you agree to keep the breeding stock dog on a leash at all times when not in a secured area? Yes
No

Question - Not Required - Do you agree to complete a basic dog obedience course within six months of dog's placement, at your own expense? Yes
No

Question - Not Required - Are you willing to work with a dog in the area of temperament or behavior modification, including, but not limited to additional training at your expense? Yes
No

Question - Not Required - Are you able to keep the dog in excellent physical condition by exercising it for a minimum of 30 minutes per day? Yes
No

Question - Not Required - Please specify how you will exercise the dog.

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

Question - Not Required - Are you able to devote time to daily grooming and parasite control at your own expense? Yes
No

Question - Not Required - Can you provide a quality dog food at your own expense (approximately $50.00 per month)? Yes
No

Question - Not Required - Do you prefer a male or female dog? Male
Female
Either

Question - Not Required - Are you willing to comply with home visitations? Yes
No

Question - Not Required - Are you or any family members allergic to dogs or to flea control products? Yes
No

Question - Not Required - Does everyone in your household want a dog? Yes
No

Question - Not Required - Who would be the dog's primary caretaker?

Please tell us about any current animals living at your home.

Question - Not Required - Type:

Question - Not Required - Age:

Question - Not Required - Sex: Male
Female

Question - Not Required - Spayed/neutered: Yes
No

Question - Not Required - Where does this animal sleep? Inside
Outside

Question - Not Required - How long have you owned this animal?

Second animal:

Question - Not Required - Type:

Question - Not Required - Age:

Question - Not Required - Sex: Male
Female

Question - Not Required - Spayed/neutered: Yes
No

Question - Not Required - Where does this animal sleep? Inside
Outside

Question - Not Required - How long have you owned this animal?

Third animal:

Question - Not Required - Type:

Question - Not Required - Age:

Question - Not Required - Sex: Male
Female

Question - Not Required - Spayed/neutered: Yes
No

Question - Not Required - Where does this animal sleep? Inside
Outside

Question - Not Required - How long have you owned this animal?

Please tell us about your previous pet history.

First pet:

Question - Not Required - Type:

Question - Not Required - Age:

Question - Not Required - Sex: Male
Female

Question - Not Required - Spayed/neutered: Yes
No

Question - Not Required - Where did this animal sleep? Inside
Outside

Question - Not Required - How long did you own this animal?

Question - Not Required - What became of this animal?

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

Second pet:

Question - Not Required - Type:

Question - Not Required - Age:

Question - Not Required - Sex: Male
Female

Question - Not Required - Spayed/neutered: Yes
No

Question - Not Required - Where did this animal sleep? Inside
Outside

Question - Not Required - How long did you own this animal?

Question - Not Required - What became of this animal?

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

Third pet:

Question - Not Required - Type:

Question - Not Required - Age:

Question - Not Required - Sex: Male
Female

Question - Not Required - Spayed/neutered: Yes
No

Question - Not Required - Where did this animal sleep? Inside
Outside

Question - Not Required - How long did you own this animal?

Question - Not Required - What became of this animal?

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

Question - Not Required - Name of a dog-related reference, such as a veterinarian, breeder, etc.:

Question - Not Required - Title:

Question - Not Required - Address:

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

Question - Not Required - Phone:

Question - Not Required - Name of a personal reference:

Question - Not Required - Relationship:

Question - Not Required - Address:

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

Breeding Stock Volunteer Application

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