GUIDE DOG PUPPY SITTING FORM
Give as much information as possible about your puppy so the sitter can give it proper care. Submit this completed form and the sitter's Diary of the Visit with the puppy report you turn in to the club leaders. Be sure to explain headcollars or other specialized equipment your puppy may be using to the sitter, so they are aware of its proper use.

PUPPY SITTER'S NAME______________________________________________________________

PUPPY & RAISER INFORMATION
It is customary for the puppy raiser to transport the puppy to and from the sitter’s home

Date dropped off _________________  Date & time puppy will be picked up______________________

Puppy’s Name:______________________________________Breed:____________Age:____________  

Sex:     __Female__Male               Has the pup been altered?   Yes      No

Raiser’s Name:___________________________________________Phone: _______________________

Address:______________________________________________________________________________

Email________________________________________________________________________________

Puppy’s Veterinarian__________________________________________Phone:____________________

If raiser will be out of town, phone number where you can be reached_____________________________
Call a leader in case of emergency or if a female comes into season.
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FEEDING & HABITS
Food:   Brand___________________________________________________________  Add Water?  Yes    No
   
Number of cups per feeding ______________________  Number of feedings per day____________________________

Special feeding/watering instructions: _________________________________________________________________

________________________________________________________________________________________________ 

Relieving: Approximately how often?_________________________________________________________________

     Will pup acknowledge the need?   Yes    No    How?___________________________________________________
           
Puppy Sleeps:     Crated  __     Tiedown __          Roams free__   Where?______________________________________
HEALTH
Medical Conditions and Instructions:________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________
TRAINING:
Circle your puppy’s level of proficiency for each command: 
Pup Does:
 On Command
 With Help
  Not Introduced
      
Pup Does:  
 On Command 
 With Help
   Not Introduced
Sit 
Down 
Stay
Let’s Go
 3
3
3
3
 2
2
2
2
 1
1
1
1
Come (FIR)
Wait
Do Business 
Go to Bed
 3
3
3
3
 2
2
2
2		 1
1
1
1
Does your puppy know its commands off leash as well as it does on leash? Yes   No

BEHAVIOR: (Circle)
In the House:                                         
In the Yard:                       
Yes    No
Yes    No
Yes    No
Yes    No
Yes    No
Yes    No
Yes    No
Yes    No
Yes    No

Other:

Excessive Barking
Relieves in house
Jumps on furniture
Steals food
Chews distructively
Plays Keepaway
Crate when left alone
Raids trash cans
Drag line  needed

____________________________

____________________________
 		Yes    No
Yes    No
Yes    No
Yes    No
Yes    No

Other:
Filth eater
Digs
Garbage mouth
Chews
Keep on leash 

__________________________

__________________________

__________________________
__________________________
On Outings:
Use Head Collar     Yes    No (If YES, be sure to instruct sitter in proper use of the head collar)

Distracted by:________________________________________________________________________________________
Afraid of:____________________________________________________________________________________________

Other:_______________________________________________________________________________________________

SOCIAL OUTINGS:

Outings appropriate for my puppy:
__ 10-15 minute in-and-out only 
__ 1-2 hour quiet (restaurant, church)
__ 1-2 hour active (grocery shopping)
 __ 2+ hour quiet (on tiedown at work)
__ Pup can handle most outings
Puppy sitters take responsibility for terminating an outing when the puppy shows signs of being overwhelmed. Be sure to give the pup ample opportunity to relieve, and clean up accidents that occur. Puppy sitters understand that puppies may be crated at home for up to four hours if the outing will be inappropriate.

Watch for These Behaviors _____________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________
Other Helpful Information:___________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Raiser Supplied Items
__Puppy coat
__Head collar & safety collar
__Leash
__Bowl(s)
__Food
 __Brush/grooming tools
__Toothbrush
__Medication
__Toys (list)  
__Tiedown 		__Kennel
__Bait Bag
__Bed Mat (Go to Bed command)
__Other_______________
_____________________



PUPPY SITTER'S REPORT
Use the back and additional pages to keep a diary of the puppy’s visit. Be honest about how the pup did, both in the home and on social outings. Your observations help identify areas of concern as well as highlight the puppy’s strengths. Attach the pages to this form and return it to the raiser or email your report to the raiser and copy Carmen. A sitter's report must be turned in every time a puppy is kept by someone other than its assigned raiser.
atl 6/2009