Application – Home Socialization (Short-term Puppy Visits)

If you are interested in becoming involved in our Home Socialization Program, this application can be filled out online & submitted electronically.

The Home Socialization Coordinator will contact you in 7- 10 business days to discuss your application in greater detail.

For additional information, please contact HS Program Coordinator at socialization@guidingeyes.org

1. First Name:(required)
2. Last Name:(required)
3. Street 1:(required)
4. Street 2:
5. City:(required)
6. State:(required)
7. Zip Code:(required)
8. Home Phone:(required)
9. Work Phone:
10. Cell Phone:
11. Preferred Contact Number:
12. Home Work Cell
13. Best time to call:
14. Email:(valid email required)
15. Secondary Email Address:
16. 1. Check which best applies below:
17. I am most interested in socializing weekdays (Mon-Fri).
18. I am most interested in socializing weekends (Fri-Mon).
19. Either of the above, depending on availability.
20. 2. What type of home do you have?
21. 3. Do you own or rent?
22. Rent Own
23. 4. If you rent, do you have the property owner's permission to have puppies on the premises?
24. Yes No
25. Please supply property owner contract information for verification.
26. 5. Please explain your history of dog ownership/raising and/or obedience training dogs.
27. 6. Is everyone in the family excited and in agreement about having puppies in the house?
28. Yes No
29. 7. Is anyone in the house allergic to animals?
30. Yes No
31. 8. How many people live in your household? Please tell us their names and ages.
32. 9. Who will be the primary caretaker of the puppies?
33. 10. How long will the puppies be alone at home each day (hours)?
    
    If it's longer than 2 hours, plan to Home Socialize only during periods when you expect to be home most of the time, since the goal is one-on-one contact for the pups.
34. 11. Where will the puppies be kept?
35. 12. What type of flooring is in this area?
    (We will provide the travel crate and indoor/outdoor x-pen.)
36. 13. Do you have other dogs? (if so, tell us how many, their breed, gender, and whether or not they are neutered)
37. 14 Date of last rabies vaccination:
38. 15. Date of last DHLPP vaccination:
39. 16. How do they react to people and to other dogs?
40. 17. Do you have other animals? If so, what kind?
41. 18. If you have cats, do they go outdoors?
42. Yes No
43. 19 If indoor cats, are they declawed?
44. Yes No
45. 20. Do your pets have fleas?
46. Yes No
47. 21. How do you control for fleas?
48. 22. Date of last rabies vaccination for cat:
49. 23. What kind of home do you have?
50. Private Home Apartment Condo Trailer
51. 24. Will you agree always to keep the puppies on a lead or supervised within the enclosed area when outdoors?
52. 25. How often would you consider Home Socializing in a year? (We ask that our socializers commit to taking puppies once a month for at least a year.)
53. 26. When are you available (months, days)? (Most stays are from 3-5 days. You will be assigned two puppies)
54. 27. Please tell us why you want to socialize puppies for us.
55. 28. If you have raised/socialized or fostered a Guiding Eyes dog previously, please tell us who they were.
56. 29. How did you learn about the Guiding Eyes program?
57. 30. Please give us a personal reference, preferably someone associated with Guiding Eyes
58. Title:
59. First Name:
60. Last Name:
61. Street 1:
62. Street 2:
63. City:
64. State:
65. Zip:
66. 31. It is helpful for us to know where you work. We will not contact your employer without first notifying you.
67. Company Name:
68. Your Title:
69. Full-Time:
70. Part-Time:
71. By submitting this form, I certify that we have studied general information about the Guiding Eyes Home Socializing program. We will comply with all of Guiding Eyes for the Blind's regulations concerning the care, safety, socialization, and feeding of the puppies while in my/our care. For safety, when the puppies are outdoors, the Socializer is required to keep them on a lead or in an enclosed area under supervision at all times. In vehicles, the puppies must be crated.

 

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