Guide Dogs for the Blind K9 Buddy Application - Youth

Parent Information

Please enter phone number with Area Code first

Please enter phone number with Area Code first

Please enter phone number with Area Code first

Please enter phone number with Area Code first

Applicant (Child's Contact Information)

Please enter Birthday as MM/DD/CCYY

Application

Maximum response 255 chars, approx. 5 rows of text


Maximum response 255 chars, approx. 5 rows of text


Please list all other members of the household not listed on this application.
Please list all ages separated by a comma.  Example 12, 10, 7

Maximum response 500 characters


Maximum response 500 characters


Maximum response 500 characters


Maximum response 500 characters


Maximum response 500 characters


Maximum response 255 chars, approx. 5 rows of text

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

You will be able to add up to 3 animals








Dog 2 currently living at your home







Dog 3 currently living at your home






Please tell us about your previous dog history.

You will be able to add up to 3 animals









Second dog history entry.








Third dog history entry.







Other Pets/Livestock.





Acknowledgment

I understand that it is my responsibility to keep Guide Dogs for the Blind informed of changes in my address and phone number, as well as changes in my interest in adopting a K9 Buddy.  I understand that a K9 Buddy dog is placed as a pet and not a service dog and therefore does not have public access.