Important Dates. The following is a checklist of what is needed. Please RSVP online at
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1 Important Dates The following is a checklist of what is needed. Please RSVP online at Complete and send in the following forms to serpuppy@cci.org: Medical questionnaire Turn-in questionnaire (this takes the place of the final monthly report). If the canine companions puppy is released form Released dog application (if applicable) five photos to serpuppy@cci.org. Review the guidelines sent to you in the matriculation packet. Canine Companions for Independence Southeast Puppy Program 8150 Clarcona Ocoee Road Orlando, FL serpuppy@cci.org Program Department Fax: (407) RSVP: 1 Canine Companions Matriculation Forms
2 Turn-in Questionnaire Name of puppy raisers and co-raisers as you would like it to appear in the graduation program: (To protect children under the age of 18, the last name of minors will not be printed. If you would like to include them please do so with one of the following examples: Jane Doe and Timmy, Jane Doe and Family, or the Doe Family) How many puppies have you raised for Canine Companions? (including the one you will be turning-in) Is the puppy is currently eating Eukanuba adult dog food. No If not, why? Will you be able to transition the puppy to Eukanuba adult dog food prior to matriculation? No Cups of food the puppy eating per day: Describe the puppy s appetite: Low Moderate High Other names the puppy responds to: Behaviors 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: 2 Canine Companions Matriculation Forms
3 Puppy s reaction when meeting new dogs: Does the puppy seek petting?: Often Sometimes Never (but seems to enjoy when its given) Never (avoids petting (aloof) Ducks away All the time Cape and Grooming Describe dog s behavior while wearing cape: Hides or runs when sees it Fine Scratches Bites at it Avoids dress, but fine once on Describe dog s behavior when Coat groomed: Nails clipped: Teeth brushed: Ears cleaned: Bathed: Energy Level Describe the puppy s overall energy level: Low Moderate High Excessive Describe puppy s activity level at home: 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 puppy? (smells, other animals, people, etc): 3 Canine Companions Matriculation Forms
4 Describe dog s reaction to cats: Fine/friendly Distracted Chases them Rarely sees one Frequent exposure- lives with cat Additional Information What is the puppy s favorite toy or type of toy? Does the puppy play fetch? 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)? No If yes, please describe: Does the puppy display any toy possession or guarding behaviors from other dogs or from people? No If yes, please describe what they guard and their body language/behavior: Does the puppy play keep-away from people or dogs? 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? 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 Does the puppy have any difficulty with surfaces? No Stairs Grates Slick floors Jumping Does the puppy like to swim? No Don t know never exposed Describe swimming experience: Ocean Stream/river Swimming pool (human) Kiddie wading pool Pond/lake Describe any history of toileting challenges or issues: 4 Canine Companions Matriculation Forms
5 List history of illness, accident, or recurring health problem: Describe any fears or anxieties exhibited by the dog including the frequency and severity of reaction: List any additional information that you think may be useful: 5 Canine Companions Matriculation Forms
6 Medical Questionnaire Dog Name: Puppy Raiser Name: While this puppy was in your care, did he/she exhibit any of the following issues? Mark yes or no and add any additional information in the space provided below: No Coughing or Sneezing No Skin Issues (itchy, infections, allergies, growths) No Chronic Diarrhea No Urinary Problems (UTI, leaking, toileting accidents) No Ear Infections No Limping (requiring treatment or x-rays) No Eye Infections/Eye Injuries No Allergic Reactions (Bee stings, reactions to vaccine or medication) No Frequent vomiting No Food Sensitivity/Allergies No Major Surgery or Medical Emergencies No Has the dog had a heat cycle? If yes list the date range of each cycle: Date the puppy will receive heart worm and flea and tick prevention prior to turn-in: Brand(s) of preventatives you are using: Veterinarian s Information: 6 Canine Companions Matriculation Forms
7 If the Canine Companions Puppy is Released Puppy: 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? 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 7 Canine Companions Matriculation Forms
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