Application for First or Successor
Guide Dog from Fidelco
To:  Fidelco Guide Dog Foundation, Inc.
102 Old Iron Ore Road
Bloomfield, CT 06002
Gentlemen:
It is my understanding that Fidelco's prime obligation is to produce the highest possible quality guide dog.
1.  In consideration for your providing me with training and instruction in the use of a trained guide dog, I agree to keep my existing homeowners or tenants
insurance, if any, in force and hereby release and indemnify you from any liability beyond your ordinary control.  It is my intent that Fidelco, being a
nonprofit organization, and its agents, representatives, successors and assigns, shall have no responsibility for personal injuries, illness or property
damage caused or sustained by me as a result of this training and instruction.
2.  I understand that either you or I can terminate this training without obligation.  However, if the training is completed to our mutual satisfaction
and a satisfactory six (6) month probationary period is completed, I will make a good faith payment to you of (a)  $150.00 as a contribution toward my
rehabilitation, and I understand I will then be qualified to receive my first Fidelco trained guide dog without further cost to me; or (b) $50.00 as contribution
toward my rehabilitation with respect to a guide dog in succession of the guide dog originally given to me and I understand I will be qualified to receive
a successor Fidelco trained dog without further cost to me.
3.  If I qualify to receive a Fidelco trained guide dog, I  understand that I shall have the choice of either owning the dog or allowing Fidelco to own
the dog.  In either case, I agree that from and after the time the dog is given to me I shall be solely responsible for it.
4.  In consideration for you providing me with a Fidelco guide dog as above described I agree:
    (a)  I will give the dog proper and humane care, as you may instruct and in accordance with Fidelco's normal care and feeding practices as communicated
to me from time to time.  It has been explained to me by Fidelco and I understand that nutrition and proper diet for the Fidelco trained guide dog is essential
to its health, strength and longevity.  I therefore pledge to carry out the recommendations of Fidelco relative to my specific dog with regard to food
and food supplements and specific medical care including all inoculations and health regimens as Fidelco may advise.  I recognize Fidelco's expertise in
this area based on more than 40 years of experience in developing its special "breed within a breed" of German shepherd dogs and I recognize that failure
to comply with the foregoing nutritional and health requirements could lead to various sorts of physical disturbances and ultimately effect the longevity
of the Fidelco trained guide dog
     (b)  I will use the dog only as my personal guide, will not abuse or mistreat the dog in any way and will not allow the dog to be used by any other person,
or for any other purpose except as may be specifically approved in writing by Fidelco in advance.  In particular, I agree not to use the dog for begging,
soliciting, or in connection with any advertising promotion or commercial activity or trade.  I agree to allow Fidelco's representatives to inspect the
dog and to survey my care and treatment of the dog at any reasonable time and I agree to provide Fidelco with formal reports (including veterinary reports)
at least once a year on the condition of the dog.
     (c)  At the point of mandatory retirement for the dog for reasons of old age or incapacity of either the dog or myself, and as determined through consultation
with Fidelco and such medical advice as is required, I will have the option to place the dog in its retirement home.
     (d)  I agree that Fidelco may repossess the dog in the event I do not comply with this agreement, in the event I do not provide proper and humane care
for the dog as determined by Fidelco in its sole judgment, or for any other reason as determined by Fidelco in its sole and absolute discretion.  In such
event, title to the dog will revert to Fidelco automatically at Fidelco's option.
     (e)  I agree that Fidelco may, in its sole and absolute discretion, enlist the assistance of any local, state, or federal authorities to repossess
the dog as provided for in this section, or to take whatever steps are necessary to ensure the safety of the dog, and I hereby agree to cooperate with
Fidelco and any such authorities to the fullest extent possible.
5.  I understand that as long as I have responsibility for the dog I may call on you for advice and consultation concerning the health and welfare of the
dog and attendant problems.  I consent to your use of my name and any photographs of me in your possession to promote and raise funds for Fidelco.  I understand
that I may withdraw this consent as to any specific use by giving you written notice.
6.  I understand that my eligibility to be considered for a successor dog in the future shall depend upon my compliance with the terms of this agreement.
7.  This agreement shall be binding upon me, my heirs, executors and assigns, and upon you, your successors and assigns.
8.  I hereby elect to:  
_____  own the dog: [Name of dog inserted here} here
                     or:  
_____ allow Fidelco to retain ownership of the dog.