It All Starts With a Puppy...and You.

Transcription

1 The Canine Companions for Independence Puppy Matriculation Packet It All Starts With a Puppy...and You. 1 Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

2 Matriculation and Turn-in Guide - February 16, 2018 At Canine Companions for Independence, our pups have a very special destiny to assist a person with a disability in leading a more fulfilling and independent life. We know that raising a puppy and then turning in the puppy is a difficult and emotional experience. Thank you for all of your time and dedication to raising a puppy. We have assembled the Puppy Raiser Matriculation Packet specifically with you, the puppy raiser, in mind. In the following pages, you will find the necessary information in chronological order to successfully turn in the puppy and enjoy a pleasant visit to the Canine Companions for Independence South Central Training Center (also known as the Kinkeade Campus). Table of Contents Important Dates Shipping Guidelines Dogs in Heat Calendar of Events Matriculation Slideshow Turn-in Pictures National Graduation Day Address of Graduation Ceremony Graduation Day The Ceremony Capes and ID Tags Turn-in Location and Directions to Turn-in Dinner Meal Turn-in Traveling With the Puppy Lodging Veterinary Exam Form Medical Questionnaire Turn-in Questionnaire Repeat Puppy Raiser Application If the Puppy is Released Release Dog Application Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

3 Important Dates The following is a convenient checklist, calendar of events and to-do list to help with the puppy turn-in experience. 1/24/18 Online RSVP due at 1/24/18 Matriculation slideshow photos due; five photos per matriculating dog. 1/24/18 Veterinary records, final vet check form, medical questionnaire, turn-in questionnaire, and final monthly progress report due. 1/24/18 Begin feeding Eukanuba Adult Large Breed Formula, if not already doing so. Canine Companions for Independence South Central Puppy Program PO Box Irving, TX bbell@cci.org Slideshow Photo SouthCentralPhotos@gmail.com RSVP: Shipping Guidelines If you will be unable to attend the matriculation/graduation ceremony in person and would like to ship the dog, please 3 Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

4 Raise a Puppy, Change a Life. contact Becca Bell immediately to make arrangements. Dogs in Heat If the puppy you are raising is in heat or comes into heat at any time during the week of graduation, please contact Becca Bell immediately at Unfortunately dogs in heat cannot attend the graduation activities or events. We understand that it is a disappointment, but we encourage you to participate so that your puppy raising efforts can be honored. Calendar of Events Status Date and Time Event or Activity Location Friday, February 16 10:00 am Friday, February 16 10:30 am Friday, February 16 12:00 noon Tour of campus including kennels (optional) Matriculation orientation and photos Graduation ceremony (open to the public) Training Center Training Center Training Center Friday, February 16 immediately following graduation Turn-in Team Lodge (the building just to the left of the Training Center, if facing campus) 4 Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

5 Matriculation Slideshow During the graduation ceremony, we present a slideshow of pictures of the matriculating class that is put together by some very talented volunteers. To have the puppy you raised included in the slideshow, please follow these guidelines: Please five horizontal (landscape layout) pictures to SouthCentralPhotos@gmail.com. Name each file with the dog s name and a number (for example, fluffy1, fluffy2, fluffy3 ). Larger file sizes are better (2 megabytes being ideal). They re easy to reduce, but hard to increase if they re low resolution. Pictures must be received by 1/24/18 to be included. Please note that pictures must follow Canine Companions guidelines or they will not be included. So please make sure the pictures show dogs safely on leash if they re not clearly in an enclosed area (that means the leash is attached to both the dog and a person) and the dog is not on furniture or doing other things considered inappropriate by Canine Companions guidelines. We d love to have at least one picture that shows the dog with the puppy raisers and one of the dog alone. Turn-in Pictures Before the graduation ceremony puppy raisers of matriculating dogs are invited to have their photo taken by a professional photographer. These photos will be made available to you a week or two after the ceremony. You will be invited to line up on a first come first serve basis. Individual photos will be taken first, and once everyone has had theirs taken you will be welcome to have any group or litter mate photos taken that you d like, time permitting. National Graduation Day Puppy raisers across the United States embark on a journey with a Canine Companions puppy that lasts approximately a year and a half. It begins with a commitment to raise a cute little fuzz ball in hopes of it becoming a Canine Companions assistance dog and ends with the trip to a Canine Companions training center for turn-in and acknowledgment at the graduation ceremony. The following information is provided to help make the journey s end a little easier. Address of Graduation Ceremony South Central Training Center 7710 Las Colinas Ridge, Irving, TX The facility is adjacent to the Baylor Surgical Hospital at Los Colinas, at the intersection of I-635 and the President George Bush Turnpike. It is across the street from the Hilton Garden Inn Las Colinas. 5 Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

6 Graduation Day Begin the day at 10:00 am with a tour of the new facility. Meet Becca in the Training Center. You ll get a chance to see the whole campus, including a walk through the kennels. At 10:30 am we ll reconvene in the Training Center for a brief orientation. During this time, you ll return the cape, Gentle Leader and ID tag that you ve been using, and will be given new equipment to use for the day. Then there will be time to socialize, have a photo taken with the puppy that you raised and give the puppy a drink prior to the ceremony (please bring your own water and bowl to avoid the spread of communicable diseases). The Ceremony The graduation ceremony will begin at 12:00 noon and will last an hour to an hour and a half. During the ceremony, you will be asked to line up so you can be announced and recognized for your contributions to the program. Capes and ID Tags Canine Companions for Independence ID tags, logo capes, Gentle Leaders, and other Canine Companions training equipment must be returned on turn-in day when you check in before the graduation ceremony. You will be given different equipment for the puppy to wear for the day. Turn-in Now that your part is done, sit back and enjoy the rest of the ceremony. Location and Directions to Turn-in Puppy turn-in will be held immediately following the graduation ceremony. It will be held in the Team Lodge building to the left of the main training building if you are facing the campus. You will check in at the registration table, then take some time to say your farewells to the puppy that you raised. There will be staff available to assist and answer any questions. 6 Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

7 Dinner Meal The puppies will be fed an evening meal after the graduation festivities, so there is no need to feed them a second meal of the day before turn-in. Turn-in When you have said your good-byes and are ready, you can hand the dog off to any volunteer or staff person. The puppy will be given a once-over by our vet tech, and a staff member will then take the puppy to meet its new roommate and get settled in. Traveling With the Puppy Some, but not all airlines will allow a Canine Companions puppy to accompany you (a passenger) in the cabin. If an airline s policy does not allow the puppy to fly in the cabin, it will need to fly as cargo in an airline-approved crate. An additional fee is generally required and they will require you to purchase a crate if you do not have one with you. It is important to note that all animals (including Canine Companions puppies) must have a travel health certificate issued within 10 days of the flight in order to fly in the cabin or as cargo. We highly recommend that you review the airlines policies before booking your flight. The following are provided as helpful tips when making your travel arrangements. Make your reservations sooner rather than later. Speak to an agent about the airlines policies regarding a dog flying in the cabin. If they do allow, inquire about exit row seating or extended legroom to allow for more space. If they do not allow, make reservations for the dog to travel as excess baggage and inquire about crate size requirements. Make a veterinary appointment within 10 days of flight and request a health certificate for travel. On travel day, feed the puppy at least two to three hours before the flight and offer plenty of toileting opportunities. Bring wipes or towels to clean up the dog in the event of an accident inside of the crate. Bring food in a Ziploc bag so that you can feed the dog if needed when you arrive. Lodging The Hilton Garden Inn Las Colinas is directly across the street from the South Central Training Center, at 7516 Las Colinas Boulevard, Irving, Texas There are a variety of other hotels in the area that may suit your needs. Please return all forms on the following pages to the Puppy Program Department no later than: 1/24/18 Thank you so much for the love, care and dedication you ve shown your puppy for the last year and a half. We look forward to celebrating all you and your puppy have accomplished at matriculation. 7 Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

8 Veterinary Exam Form Puppy s Name: Date: Puppy Raiser Name(s): Veterinary Clinic Name: Veterinary Clinic Address: Breed: Tattoo #: For Veterinarian to complete as thoroughly as possible Veterinarian s Printed Name: Veterinarian s Signature: Date of exam: Vaccines were provided on: This dog has been spayed or neutered on: or This dog has not been spayed or neutered Current weight: Good working weight?: (Overweight by: Underweight by: ) Comments: Ears Normal?: Describe: Can you see the eardrum clearly?: Teeth: Annual dental needed?: Comments: Fecal Analysis Done?: Rx: Skin Problems? Hot Spots Fleas Dry Skin Other: Gastrointestinal problems?: Describe: Lameness?: Describe: Any chronic problems?: Describe: Does Canine Companions dog appear to be in good health? Comments: Any other comments or concerns?: Please include a complete copy of the dog s medical history 8 Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

9 Medical Questionnaire Medical History Questionnaire Puppy Raiser Name: Dog Name: Tattoo #: While this puppy was in your home, did he/she exhibit any of the following issues? Please circle yes or no, and add additional notes to explain. COUGHING OR SNEEZING YES NO SKIN ISSUES (itchy, infections, allergies, growths) YES NO CHRONIC DIARRHEA YES NO URINARY PROBLEMS (UTIs, leaking, toileting accidents) YES NO EAR INFECTIONS YES NO LIMPING (that needed treatment or x-rays) YES NO EYE INFECTIONS/INJURIES YES NO ALLERGIC REACTION (bee stings, vaccine reactions, medication reactions) YES FREQUENT VOMITING YES NO NO 9 Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

10 FOOD SENSITIVITY/ALLERGIES YES NO MAJOR SURGERY OR MEDICAL EMERGENCIES YES NO PRIMARY VETERINARIAN INFORMATION CLINIC NAME: VETERINARIAN NAME: TELEPHONE NUMBER: ADDITIONAL VETERINARY INFORMATION CLINIC NAME: VETERINARIAN NAME: TELEPHONE NUMBER: Please add any additional information about the puppy s medical history that may be useful you may attach an additional page if necessary: 10 Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

11 Turn-in Questionnaire Please mail or these records. Puppy Name: Puppy Raiser(s): Name(s) the puppy responds to other than his/her Canine Companions name: Please list the best phone number to contact you if we need to provide you with information about the puppy you raised while they are in professional training: Please list an alternate phone number (required): For female pups, please list the dates of all heat cycles: We would appreciate information about the puppy that you raised. It will be valuable to the kennel staff and Canine Companions instructors who will be interacting with him or her. You are the best source of information on the puppy s training and past experiences. Please complete the following questions and provide any additional information you think would be helpful for the puppy s transition into professional training. Food: Brand and type of food puppy is eating at time of turn-in: Quantity of food per day puppy is currently eating: Current weight of puppy: Describe the puppy s appetite (choose one) Low Moderate High List history of illness, accident, or recurring health problem: Describe any history of toileting challenges or issues: Describe the puppy s behavior with people: Puppy s reaction when meeting one child: Puppy s reaction when meeting groups of kids: Puppy s reaction when meeting known adults: Puppy s reaction when meeting new adults: Puppy s reaction when meeting new dogs: Does the puppy seek All the time Often Sometimes Never, but seems to out petting: enjoy when given it Never, and avoids petting (aloof) Ducks away 11 Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

12 Cape and Grooming: Describe dog s behavior while wearing cape: Describe dog s behavior when Coat groomed: Nails clipped: Teeth brushed: Ears cleaned: Bathed: Hides or runs when sees it Fine Scratches Bites at it Avoids Dress but fine once on Energy Level: Describe the puppy s overall energy level: Describe puppy s activity level at home: Low Moderate High Excessive Low management- never steals or chews. Hangs out or sleeps most of the time Moderate- will chew or steal if not exercised enough or not supervised High- needs close supervision when not crated; active; initiates play often What was most distracting to the dog (smells, other animals, people, etc): Describe dog s reaction to cats: Fine/friendly Distracted Chases them Rarely sees one Frequent exposure- lives with a cat Additional Information: Does the puppy like to swim? Yes No Don t know never exposed Describe swimming experience: Ocean Stream/river Swimming pool (human) Kiddie wading pool Pond/lake Describe any fears or anxieties exhibited by the dog including the frequency and severity of reaction: 12 Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

13 What is the puppy s favorite toy or type of toy? Does the puppy play fetch? Yes No If so, how long will they play with you one-on-one? Just a few throws For a little while, then loses interest As long as someone will keep throwing! Does the puppy s interest in playing fetch change when other dogs are around (rather than one-on-one)? Yes No If yes, please describe: Does the puppy display any toy possession or guarding behaviors from other dogs or from people? Yes No If yes, please describe what they guard and their body language/behavior: Does the puppy play keep-away from people or dogs? Yes No If yes, please describe: Does the puppy tend to drop toys: On the ground in front of you In your hand Does not drop Has the puppy been on an airplane other than when they were 8 weeks old? Yes No If so, please describe the puppy s reaction to the experience: Is the puppy comfortable walking on both the left and the right side of the handler? No Yes Does the puppy have any difficulty with surfaces? Stairs Grates Slick floors Jumping Please describe: 13 Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

14 List any additional information you think may be useful: 14 Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

15 CANINE COMPANIONS FOR INDEPENDENCE VOLUNTEER PUPPY RAISING PROGRAM VOLUNTEER POSITION: REPORTS TO: COMMITMENT: Puppy Raiser Regional Puppy Program Manager Approximately months OVERVIEW: The volunteer puppy raising program is of extreme importance to the CCI program; it establishes the foundation of early experiences, which are critical in preparing the puppy for Advanced Training. This project involves four major areas of personal and financial responsibility: 1) Providing for the care and well-being of a CCI puppy: a) A safe home environment b) Food and other supplies required for puppy raising c) Healthcare - preventative healthcare, spay or neuter at 6 months of age (when requested by the puppy program), and any other incidental healthcare requirements. 2) Enrollment and participation in CCI or CCI-approved obedience classes for the duration of the project. Volunteer puppy raisers are also required to submit a progress report each month for the duration of the project as well as report behavioral or medical problems to the regional puppy program manager. 3) Socialization, which involves systematically exposing the puppy to a variety of environmental and situational experiences. Volunteer puppy raisers agree to follow CCI approved socialization guidelines and handling techniques when working with the CCI puppy. 4) Transportation, which may include shipping costs (for puppies flying directly to the puppy raisers) as well as the costs associated with returning the puppy to one of CCI s regional training centers for Advanced Training. REQUIREMENTS: Willingness and ability to commit to the outlined responsibilities; Volunteer puppy raisers must have the ability to safely house and care for a puppy from eight weeks of age until the required turn-in date (approximately months). Volunteer puppy raisers must be willing and able to devote time each day to oversee the complete care of the puppy: feeding, grooming, socialization, and exercise as recommended by CCI Puppy Program staff. TRAINING PROVIDED: Orientation to the CCI Puppy Program, CCI puppy obedience classes (limited availability) REFERENCE MATERIALS: Puppy Raiser Orientation Folder and Puppy Raiser Manual I have read and understand the above guidelines required for participation in the Volunteer Puppy Raising Program for Canine Companions for Independence. Volunteer Name (Print) Volunteer Signature Date Volunteer Name (Print) Volunteer Signature Date Rpt Raiser rev. 6/18/ Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

16 APPLICANT REPEAT PUPPY RAISER APPLICATION Name: Address: City: City: County: State: Zip Code: County: Home Phone: Cell Phone: Work Phone: Best Number to Call: Work Home Cell Date of Birth: Gender: Male Female Employer: Co-Applicant (required for persons under 18 yrs of age) Name: Address: City: State: Zip Code: County: Home Phone: Cell Phone: Work Phone: Best Number to Call: Work Home Cell Date of Birth: Gender: Male Female Employer: Please list the names of the puppies and the dates you raised for CCI: What did you enjoy the most about puppy raising? What was the hardest part? Is there anything you would do differently or to improve your handling of the puppy? Please list trainer or training center you worked with: Did you submit monthly progress reports in a timely manner each month? Yes No How often did you attend puppy obedience classes? Weekly Bi-weekly Monthly Did you keep the CCI puppy (or puppies) in your care at an ideal weight and adhere to CCI s feeding and preventative care protocols? Yes No Comments: Rpt Raiser rev. 6/18/ Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

17 PETS Please list all animals currently in your home: Animal Name Breed Age Sex Spayed/Neutered? Other notes/comments? Please list behavior exhibited by one or more of the dogs in your home: Alert barking at door knock Protects food or toys (from people or dogs) Aggression (people or dogs) Other: Describe: Has anything changed for you since you last raised a puppy (address, employer, schedule, children etc.)? Yes No Please describe: Are you willing to raise any puppy, regardless of breed, color, or sex? Yes No Are you willing and able to pay for all veterinary care of the CCI puppy? Yes No Are you willing and able to pay for feeding and other basic care of the CCI puppy? Yes No Are you willing and able to pay for all transportation expenses for the CCI puppy to and from the training center? Yes No Do you have the physical ability to lift, correct, or restrain a 75-pound dog? Yes No Do you have a fully enclosed/fenced yard? Yes No If your application is accepted, when will you be ready to raise a puppy? VETERINARY CARE Please list the names of your veterinarian or the veterinarian you have selected for the CCI puppy. Name: Address: City: State: Zip Code: Phone: To the best of my knowledge, the above information is true and accurate. I agree to provide additional information upon request. By submitting this application electronically, I agree that the name on this application has the same effect as if I signed a hard copy of this application. I agree* Applicant name (print): Applicant signature: Date: Co-applicant name (print): Parent signature if under 18 years of age: Date: Please read, print and sign the application and Agreement to Terms of Service before returning to CCI. Rpt Raiser rev. 6/18/ Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

18 AGREEMENT TO TERMS OF SERVICE EVERY PERSONS APPLYING TO RAISE A CCI PUPPY MUST COMPLETE THIS AGREEMENT AND RETURN WITH THE PUPPY RAISER APPLICATION. 1. I understand that the dog I am raising belongs to CCI. 2. I am required to follow the training and socializing guidelines presented to me by CCI. 3. I am required to attend regular obedience classes either at CCI or privately or both if deemed necessary. 4. I am required to submit monthly progress reports and to promptly report behavioral, medical or training issues to CCI. 5. I am responsible for and assume financial responsibility for the puppy s general and veterinary care. 6. I agree to follow CCI s recommended vaccine schedule, treatment protocols and preventative care guidelines. 7. The puppy is to remain intact unless otherwise determined by CCI staff. 8. I will notify CCI when the female is in heat and agree to board the intact female at a CCI approved facility for the duration of every heat cycle. I will be reimbursed for the actual daily net kennel charge. 9. I will send all veterinary records incurred during the time that I am raising the CCI puppy including proof of vaccinations, rabies and sterilization (if applicable) before the puppy returns for advanced training. 10. I may be required to have hip and elbow x-rays taken at my expense. 11. The puppy must eat a quality dog food recommended and approved by CCI. The puppy must not be allowed to become overweight. 12. The puppy must be well versed in being handled for grooming, teeth brushing, and nail trimming. 13. I am required to teach the puppy to be well mannered, crate trained and friendly to people and animals. 14. I will not allow the puppy to be off leash unless in an enclosed safe area. Long lines and flexi-leashes may be used. 15. The dog may be placed with a graduate in any of the 50 United States or in any country that CCI serves. Additionally, I may be asked to return the puppy to any one of CCI regional centers for advanced training. 16. I understand that any decision about the dog s placement is to be made by CCI staff. 17. The dog may be placed at any time as determined by CCI staff and, as a result, might not participate in a graduation ceremony. 18. If the dog is not placed as a CCI graduate, the dog may be offered to another assistance dog school or alternative agency (such as search & rescue/drug detection) solely at the discretion of the regional program staff prior to its release back to the puppy raiser. 19. If I choose not to adopt the dog that I raise back as my personal pet, I may not take him/her back and/or place or transfer it to any other person or agency. All decisions regarding final placement will be made by CCI staff. 20. If this agreement is not maintained, the dog will be placed with someone else and/or I will not be eligible to puppy raise for CCI. 21. CCI puppy program staff is available to assist me with any concerns or problems I encounter during my puppy raising experience. I have read and understand the above requirements to be a CCI Puppy Raiser. My signature signifies acceptance of all the terms stated above. Applicant signature: Date: Co-Applicant signature: Date: Parent signature if under 18 years of age: Please send completed application to the nearest CCI regional center or call for assistance. Rpt Raiser rev. 6/18/ Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

19 If the Canine Companions Puppy is Released Puppy s Name: Puppy Raiser: I plan on adopting the dog mentioned above as my permanent pet. *For those interested in raising another puppy. Canine Companions for Independence policy states that puppy raising homes cannot have more than a total of four dogs in the home, including a Canine Companions puppy in training. I do not plan on adopting the dog. Canine Companions for Independence will find the dog I raised a suitable home. I do not plan on adopting the dog. I would like a close friend or family member to be considered. (Please complete the attached released dog application.) Name of interested party: Relationship to puppy raiser: Does the interested party have a release dog application on file? Yes No 1. Application must be on file prior to the dog entering professional training. 2. It is the responsibility of the puppy raiser to make sure interested parties have sent in the application for that specific dog. 3. Applications are only good for an individual dog. Applications will be inactivated when a dog graduates and/or is placed in another home.... Office Use Only Released dog application attached to PIP file No released dog application received 19 Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

20 Released Dog Application If applicable. Not required if the puppy raiser plans to adopt the dog they raised. Canine Companions for Independence Release Dog Application Persons applying for a released dog must be willing to travel, at their own expense to a CCI campus within 1 week of being notified that a potentially suitable dog is available. Indicate which facility you would come to meet a dog? (Please send this completed application directly to the facility you indicate.) Northwest Region PO Box 446 Santa Rosa, CA Southwest Region PO Box 4568 Oceanside, CA North Central Region 4989 State Route 37 E Delaware, OH Northeast Region 286 Middle Island Rd Medford, NY Southeast Region PO Box Orlando, FL South Central Region PO Box Irving, TX APPLICANT Name: Address: City/State/Zip: Telephone: Home ( ) Work ( ) Age: Why do you want a CCI released dog? For Office Use Only OTHER MEMBERS OF HOUSEHOLD Name: Relation to applicant: Age: Name: Relation to applicant: Age: Name: Relation to applicant: Age: Name: Relation to applicant: Age: Name: Relation to applicant: Age: HOUSEHOLD How long at present address? Do you own or rent your home? own rent If renting, provide landlord s name and phone: Do you have a securely fenced yard? yes (Fence height: ) no An enclosed dog run? yes (Fence height: ) no Is anyone in your home allergic to dogs? yes no Have you ever taken a dog through obedience classes? yes no Are you willing to use a dog crate? yes no What is the number of hours per day the dog would spend alone (without people)? Where would the dog be when alone? Canine Released Dog Application Rev 1/19/ Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

21 PETS Please list all dogs currently in your home and/or that you have had in the past: Breed Age Sex Spayed/Neutered? What became of this dog? (If no, why not?) For Office Use Only Comments: Please list all other pets in your home include age and sex of each animal: VETERINARY CARE Please list the names and addresses of veterinarians that see or have seen your pets? PREFERENCES The dogs available for adoption are purebred Golden Retrievers, Labrador retrievers (black and yellow) and Labrador/golden retriever crossbreds. Please indicate breed and gender preferences: BREED Labrador Retriever Golden Retriever Labrador/Golden Retriever Crossbred SEX Female Male No Preference AGE Under 1 year of age 1-5 yrs 5 yrs or older Most dogs released from the program are young adult dogs that are deemed unsuitable to become assistance dogs for medical or behavioral reasons. Occasionally, a retiring assistance dog may be available (age of dog is anywhere from 8-12 years or older). Are you applying to adopt a retiring assistance dog? yes no Are you willing to accept a dog released for a medical condition? yes no Medical reasons may include but are not limited to the following, please check those you would consider: Auto-immune disorder Allergies Cataracts Epilepsy Heart problem Hip/elbow dysplasia Other vision problems Urinary tract infections (chronic) Comments: Canine Released Dog Application Rev 1/19/ Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.

22 Some of the behavioral characteristics that preclude a dog from becoming an assistance dog may require additional training and/or appropriate management/supervision. However, due to our limited staff resources and time available CCI does not provide ongoing training or support for released dogs and their handlers. Are you willing to seek, acquire and take financial responsibility for any additional training? yes no Please check the characteristics that you are able and willing to work with: For Office Use Only Aggression (dogs/cats/other animals) Aggression (people) Assertiveness (requiring strong leadership) Excessive (inappropriate) Barking Excessive Energy Level Fearful Behavior (sensitivity to unfamiliar noises/people/objects) Inappropriate Chewing/Digging Separation Anxiety Toileting Issues (not house broken, marking, submissive urination, indiscriminate toileting) Training Issues (low trainability, distractibility) Comments: I understand that dogs released from the program are not suitable for placement to work with a person with a disability. I agree, therefore not to attempt to place a released dog as an assistance dog, either on my own or through a third party. I understand that violating this agreement makes me ineligible to act as a puppy raiser, volunteer or release dog adopter for CCI in the future. I understand that completing this application does not guarantee that I will receive a dog from Canine Companions for Independence (CCI). I understand that (CCI) matches each individual dog with a home that meets the specific needs of the dogs and the adopter(s). Therefore, placement with a dog is not based on the length of time an application is on file and there is no way to predict if or when an appropriate dog may become available. I understand that there is a $ 500 adoption fee for a released dog (fee may be waived for dogs with serious medical conditions). I understand that it is my responsibility to keep CCI informed of changes in my address and phone number as well as changes in my interest in adopting a dog. I understand that my application will be kept on file for a two-year period. After that time, I will need to submit a new application for further adoption consideration. To the best of my knowledge, the information that I have provided on this Release Dog Application is true and accurate. To the best of my knowledge, the above information is true and accurate. I agree to provide additional information upon request. By submitting this application electronically, I agree that the name on this application has the same effect as if I signed a hard copy of this application. I agree* Signature(s): Applicant Date Applicant Date *Please attach a recent photo of yourself and your home and yard space. Canine Released Dog Application Rev 1/19/ Canine Companions Matriculation Packet 2016 Canine Companions for Independence. All rights reserved.