RMBB Puppy Raiser Application

First name*

Last name*

Email*

Phone

Address

Have you raised a service dog? If yes, for what organization?*

Do you have any pets in your home? If so, what is age/breed?*

Residence Type:*

Single Family Home

Apartment/Condo/Townhome

Rural/Farm

College Dorm/University Housing

Do you own or rent?*

Own

Rent

Where did you hear about our organization?

Is anyone in your household allergic to dog?*

Yes

No

Are any members of your household afraid of dogs?*

Yes

No

Are you a college student? If so, what univeristy?

Are you able/willing to fundraise?

Do you have children? If so, what are their ages?

When are you available to receive a puppy?*

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