Veterans Moving Forward, Inc.
P.O. Box 404, Catharpin, VA 20143
1-866-375-1209  www.vetsfwd.org
Puppy Raiser Application
Applicant’s Name: _____________________________________________________________
Age: ____ Sex:  M  F
Occupation: __________________________________________
Co-applicant’s Name:___________________________________________________________
Age: ____ Sex:  M  F
Occupation: __________________________________________
Address: ____________________________________________________________________
City: __________________ County: ___________ State: ___________ Zip: ______________
Preferred means of communication:  Phone ( home;  work;  cell)  E-mail
Best time to call_________
Daytime phone number:
_____________
 work  home  cell
Evening phone number:
_____________
 work  home  cell
Other (Please specify):
_____________
 work  home  cell
E-mail address: ______________________________________________________________
Are you a Veteran?  Yes  No Active Duty Military  Yes  No
Name you prefer we use for correspondence and certificates: ___________________________
Do you want to be a  short-term (weekends, a few weeks, etc.) or  long term (up to two
years) Puppy Raiser? Are you willing and capable of fostering a  young (8 week-old) puppy or
an  adolescent puppy (9-20 months)? Other: ______________________________________
Please list all those living with you and whether anyone in the household is allergic to animals:
Name
Relationship
Gender M/F
Age
Home during
the day
Allergic to Dogs
M F
 Yes  No
 Yes  No
M F
 Yes  No
 Yes  No
M F
 Yes  No
 Yes  No
M F
 Yes  No
 Yes  No
M F
 Yes  No
 Yes  No
M F
 Yes  No
 Yes  No
(family member,
friend, colleague)
If you or another member of your household are home during the day, please provide details
(who, how often, how many hours, etc.). ___________________________________________
____________________________________________________________________________
Page 1
VMF, Inc., Proprietary
As of Jan. 5, 2013
Veterans Moving Forward, Inc. is a 501(c)(3) public charity that provides service dogs
to veterans with physical and mental health challenges.
Puppy Raiser Agreement
Housing
 Home –  Own  Rent
Apartment –  Own  Rent  Other (please describe): _________
 Yard – with fence  Yard – without fence – If you do not have an enclosed yard, are you
able/willing to enclose your yard or build a kennel or run?  Yes  No
Will you agree always to keep the puppy on a lead or supervised within an enclosed area when
it is out-of-doors?  Yes  No
If you rent, please give your landlord’s name: _______________________________________
Landlord’s daytime phone #: __________________ E-mail: ____________________________
Please briefly describe your home, yard and living environment: _________________________
____________________________________________________________________________
____________________________________________________________________________
Please briefly describe your daily routine: ___________________________________________
____________________________________________________________________________
____________________________________________________________________________
How did you hear about the VMF ADIT- program? ____________________________________
____________________________________________________________________________
Have you ever applied to raise a VMF ADIT before?  Yes  No If yes, when? ____________
Have you previously raised a puppy for service or therapy dog work?  Yes  No If yes,
please provide details, including organization, dog breed, placement, etc.: _________________
____________________________________________________________________________
Do you have a preference regarding the puppy?  Yes  No Gender –  Male  Female
Breed –  Labrador Retriever  Golden Retriever (Note: VMF primarily uses retrievers)
 Other: ________________________  Color (please specify): ________________________
What are your reasons for wanting to raise a VMF ADIT?_______________________________
____________________________________________________________________________
____________________________________________________________________________
Do you currently have any pets other than dogs?  Yes  No If yes, please describe (sexneutered/spayed, cat, bird, etc.): __________________________________________________
____________________________________________________________________________
Do you currently have any dogs?  Yes  No If yes,  House dog  Outside dog Please
describe (breed, age, sex, neutered/spayed, level of training/obedience, etc.): ______________
____________________________________________________________________________
Does your pet have any medical or behavioral issues?  Yes  No If yes, please provide
details: ______________________________________________________________________
Have you ever attended any formal dog obedience training?  Yes  No If yes, please
provide details: ________________________________________________________________
____________________________________________________________________________
Page 2
VMF, Inc., Proprietary
As of Jan. 5, 2013
Veterans Moving Forward, Inc. is a 501(c)(3) public charity that provides service dogs
to veterans with physical and mental health challenges.
Puppy Raiser Agreement
Can you provide proof of vaccination for the animals listed above?  Yes  No
If you raise a VMF ADIT, where would the puppy sleep at night? (VMF puppies must be raised as
house dogs and comfortable in a crate/kennel.) __________________________________________
Who will be mostly responsible for training the puppy? ________________________________
____________________________________________________________________________
Will all members of your family help reinforce the training or participate?  Yes  No
What is your primary mode of transportation: ________________________________________
How do you intend to transport the puppy (select all that apply):  Crate  Pet Seatbelt
 Vehicle barrier  Tether and Harness  Other (please specify): ______________________
Will you be able to take the VMF ADIT to your workplace?  Yes  No If yes, how often?
____________________________________________________________________________
Will your employer provide a letter stating you have approval to have a VMF ADIT at work with
you?
 Yes  No If yes, please attach to this application.
Please describe your work environment: ___________________________________________
___________________________________________________________________________________
Where would the puppy be while at work with you (cubicle, private office, restricted to one
location or free to roam, etc.)? ____________________________________________________
___________________________________________________________________________________
Please describe a typical day for you (work day and weekend): ____________________________
___________________________________________________________________________________
___________________________________________________________________________________
Please provide the name and address of your employer:
Name: ______________________________________________________________________
Address: ____________________________________________________________________
City: __________________ County: ___________ State: ___________ Zip: ______________
Do you/your family travel (locally, out of state, out of country)?  Yes  No How often? How
long? _______________________________________________________________________________
___________________________________________________________________________________
About how much time per day do you plan to spend training the VMF ADIT? Growing puppies
need exercise (fast walking or vigorous play) at least twice a day in addition to many hours of
interaction with the family. Are you willing to provide exercise before and after school or work?
 Yes  No If yes,  10-20 minutes  20-30 minutes  more than 30 minutes
Is the family willing to travel to a central location for orientation before you get a puppy and for
subsequent VMF ADIT evaluation meetings?  Yes  No
Will you agree to attend evaluation meetings and obedience training classes?  Yes  No
At least five times a week, ADIT puppies need to be taken on sidewalks, around people, to
varied areas, and as they mature to busy towns. You must concentrate and place all your
attention on the puppy for this kind of socialization. Are you willing to do this?  Yes  No
Page 3
VMF, Inc., Proprietary
As of Jan. 5, 2013
Veterans Moving Forward, Inc. is a 501(c)(3) public charity that provides service dogs
to veterans with physical and mental health challenges.
Puppy Raiser Agreement
Do you have any experience working with people with disabilities  Yes  No If yes, please
describe: ____________________________________________________________________
Do you believe you will be able emotionally to handle the separation when the puppy returns to
VMF for advanced training and subsequent placement with a veteran with a disability?
 Yes  No Comments: ______________________________________________________
___________________________________________________________________________________
Are you willing to raise any puppy, regardless of breed, color, or sex?
 Yes  No
Are you willing and able to pay for  all or  some of veterinary care
of the VMF ADIT?
 Yes  No
Are you willing and able to pay for  all or  some of the feeding
and other basic care of the VMF ADIT?
 Yes  No
Are you willing and able to pay for  all or  some of the transportation
expenses for the VMF ADIT to and from the advanced training center?
 Yes  No
Do you have the physical ability to  lift and  restrain a 75-pound, injured dog?  Yes  No
If your application is accepted, when will you be ready for a VMF ADIT? __________________
Please provide the name and address of your veterinarian:
Name: ______________________________________________________________________
Address: ____________________________________________________________________
City: __________________ County: ___________ State: ___________ Zip: ______________
Do you belong to a service club or organization, e.g., MOAA, NCOA, American Legion, VFW,
BPOE, Girl Scouts, Boy Scouts, etc.  Yes  No If so, what is the name and location of your
club? _______________________________________________________________________
To the best of my knowledge, the above information is true and accurate. As a VMF Puppy
Raiser, I agree to adhere to all requirements of Veterans Moving Forward, Inc., and to be
responsible for the care, feeding and training of my canine placement during the period that the
puppy is in my home. I agree to return the puppy to VMF upon request.
Applicant’s Signature: _________________________________ Date: __________________________
Print Applicant’s Name: ________________________________________________________________
Co-Applicant’s Signature: _______________________________ Date: __________________________
Print Co-Applicant’s Name: _____________________________________________________________
Please carefully read and sign the Responsibilities and Commitments of a VMF Puppy
Raiser Agreement (pages 5-6 of this application) before returning the completed
application to Veterans Moving Forward.
Please return this completed application to:
VETERANS MOVING FORWARD, INC., P.O. Box 404, Catharpin, VA 20143
or scan and create a PDF document and send as an e-mail attachment to admin@vetsfwd.org.
Page 4
VMF, Inc., Proprietary
As of Jan. 5, 2013
Veterans Moving Forward, Inc. is a 501(c)(3) public charity that provides service dogs
to veterans with physical and mental health challenges.
Responsibilities and Commitments
of a Veterans Moving Forward, Inc. (VMF) Puppy Raiser
Puppy Raiser Agreement
(to be signed again on receipt of a VMF ADIT)
Thank you for making the commitment to raise an assistance/service dog for VMF. Preparing a
valuable puppy to become an assistance dog is an important responsibility; one we know you
have given serious consideration. The VMF staff and training team stand ready to assist you,
every step of the way. If a situation arises, such as a change of employment, a relocation or
residential move, or if the puppy is proving to be “not a good fit” for your household, VMF will
move the puppy to accommodate your needs as well as those of the puppy. Behind every
assistance/service dog is a caring team of puppy raisers like you who gives his or her love, time
and resources so that a veteran can know the dignity of greater independence and improved
wellness. It will not be easy when the pup leaves you after approximately 15-18 months, but
your sadness will be offset by the joy of helping one of our Nation’s deserving veterans.
The Puppy Raiser of a VMF ADIT understands and agrees to the following:
1. VMF is the sole owner of the ADIT and therefore maintains sole authority regarding all
aspects of the ADIT’s well being, including (but not limited to) its health, safety,
socialization, temperament, training and placement.
2. The Puppy Raiser is required to obtain regular vaccinations for the ADIT in accordance with
VMF guidelines. Rabies Certificates and proof of vaccinations will be provided to VMF. The
Puppy Raiser must obtain a town or state dog license where required by law and a Raiser
ID tag with the Raiser’s contact information on it. The ADIT must wear a buckle collar with all
ID tags at all times, whether the ADIT is in or out of the house.
3. The Puppy Raiser is required to use flea/tick control and heartworm medications in
accordance with the direction of his/her veterinarian. The Puppy Raiser is responsible for
ensuring that the ADIT receives the above-referenced medications on the first day of the
month. The Raiser periodically will submit fecal samples for testing for intestinal parasites.
4. The ADIT’s safety is very important. The ADIT is not to be off leash, unless he/she is in an
enclosed, safe area, and supervised at all times when outdoors.
5. The Puppy Raiser will use the crate according to VMF policy. VMF shall provide a crate for
the ADIT. This crate remains the property of VMF and shall be returned, when requested, in
similar condition as when received.
6. The ADIT always will be transported safely using a crate or an approved pet vehicle
restraint.
7. The Puppy Raiser is required to ensure that the ADIT maintains appropriate weight in
accordance with DVM and VMF guidelines. The ADIT is not to be overweight. The Raiser
will provide the name of the high quality, large breed, dry dog food to VMF for its record, if
not feeding the ADIT from the Blue Buffalo Co., brand. NO human food is allowed, unless
specifically prescribed by the DVM.
8. The Puppy Raiser will attend all required meetings and appointments including, but not
limited to, veterinary appointments, scheduled ADIT assessments, training classes and any
appointments associated with the health, safety, or behavior of the dog. If any of the above
poses a challenge, the Puppy Raiser and VMF staff will work together to find a suitable
arrangement.
9. The ADIT must be well mannered (not jumping on people, pulling on leash, or licking
excessively) and house-trained and able to toilet, on command, when on a six-foot leash.
Page 5
VMF, Inc., Proprietary
As of Jan. 5, 2013
Veterans Moving Forward, Inc. is a 501(c)(3) public charity that provides service dogs
to veterans with physical and mental health challenges.
Responsibilities and Commitments
of a Veterans Moving Forward, Inc. (VMF) Puppy Raiser
Puppy Raiser Agreement
10. The Puppy Raiser is required to socialize the ADIT and display proper puppy etiquette -wearing its red, VMF “in training” bandana or vest/jacket, and being properly groomed, clean
and healthy -- when in public, after his/her second set of vaccinations.
11. The ADIT must be well versed in being handled for grooming, teeth brushing, and nail
clipping or trimming.
12. The Puppy Raiser will have the ADIT spayed/neutered in accordance with the advice of
his/her veterinarian and in coordination with the VMF management team and provide
documentation of sterilization.
13. The Puppy Raiser is required to send periodic (electronic) progress reports to VMF. An initial
form will be provided by VMF.
14. The Puppy Raiser understands that the VMF ADIT cannot be left unsupervised with children
under the age of 14, nor should it be tugged, pulled or handled roughly.
15. The Puppy Raiser never will apply an electronic device, e.g., underground/fencing device or
“Shock Collar” to the VMF ADIT.
16. The Puppy Raiser agrees to comply with all VMF policies outlined in the VMF Policy Manual.
VMF reserves the rights to modify its policies at any time. Current policies are posted on the
VMF Web site (www.vetsfwd.org). VMF reserves the right to re-home the dog and/or dismiss
the Puppy Raiser from the ADIT Program if he or she is not in full compliance with VMF
policies. Upon notification by VMF of its intent to re-home the dog and/or dismiss the Puppy
Raiser, the raiser agrees to return promptly the ADIT to VMF.
17. The Puppy Raiser understands that if the dog does not complete assistance dog training it
will be evaluated for another role in support of veterans. It may be re-designated as a VMF
“comfort” or therapy dog or placed with a veteran as a companion.
18. The assistance/service dog may be placed with a veteran in any of the 50 United States.
VMF’s President will make the final decision regarding the dog’s placement.
I have read and understand the above requirements to be a VMF Puppy Raiser. My
signature indicates acceptance of all the terms stated above.
Applicant’s Signature: _________________________________ Date: __________________________
Print Applicant’s Name: ________________________________________________________________
Co-Applicant’s Signature: _______________________________ Date: __________________________
Print Co-Applicant’s Name: _____________________________________________________________
VMF Representative’s Signature: ________________________ Date: __________________________
VMF’s Representative’s Name and Position: ________________________________________________
Please return this completed agreement to:
VETERANS MOVING FORWARD, INC., P.O. Box 404, Catharpin, VA 20143
or scan and create a PDF document and send as an e-mail attachment to admin@vetsfwd.org.
Page 6
VMF, Inc., Proprietary
As of Jan. 5, 2013
Veterans Moving Forward, Inc. is a 501(c)(3) public charity that provides service dogs
to veterans with physical and mental health challenges.
Responsibilities and Commitments
of a Veterans Moving Forward, Inc. (VMF) Puppy Raiser
Photo and Media Release
Veterans Moving Forward (VMF) Photo and Media Release
I hereby grant Veterans Moving Forward permission to use my likeness and/or my name in any
and all of its publications, including its web site (www.vetsfwd.org), promotional and educational
material. I also understand that these materials will become the property of Veterans Moving
Forward and will not be returned. I hereby irrevocably authorize VMF to edit, alter, copy, exhibit
or distribute this photo or video for purposes of publicizing VMF’s programs or for any other
lawful purpose. In addition, I waive the right to inspect or approve the finished product.
Additionally, I waive the right to any royalties or other compensation arising or related to the use
of the photograph or video.
I am at least 18 years of age and am competent to contract in my own name. I have read this
release before signing below, and I fully understand the meaning of this release.
Signature: ___________________________________________ Date: ___________________________
Print Name: __________________________________________________________________________
Dog’s Name: _________________________________________ ID: _____________________________
If the person signing is under age 18, there must be consent by a parent or guardian, as follows:
I hereby certify that I am the parent or guardian of ________________________, named above, and do
hereby give my consent without reservation to the foregoing on behalf of this person.
Parent/Guardian’s Signature: ____________________________ Date: ___________________________
Print Name: __________________________________________________________________________
Please return this completed release to:
VETERANS MOVING FORWARD, INC., P.O. Box 404, Catharpin, VA 20143
or scan and create a PDF document and send as an e-mail attachment to admin@vetsfwd.org.
Page 7
VMF, Inc., Proprietary
As of Jan. 5, 2013
Veterans Moving Forward, Inc. is a 501(c)(3) public charity that provides service dogs
to veterans with physical and mental health challenges.