Application Form

Thank you for your interest in our service dog program. To receive more information about our specific service dogs and find the perfect match for your needs, please take a moment to fill out our application form below. We kindly request detailed information about your requirements, preferences, and any specific tasks or support you are seeking from a service dog. Rest assured that all information provided will be treated with the utmost confidentiality. Once we receive your application, our dedicated team will carefully review it and reach out to you with more information tailored to your specific needs. We appreciate your trust in our program and look forward to assisting you in finding the ideal service dog companion.

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Recipients Name

If the above answer is no, please fill out your name as the point of contact. All questions after please fill out with recipients information.

Phone

Address

Please describe your living situation (house, apartment, condo, dorm, ect)

Do you have a fenced in yard? If so how what is the height of fence?

How many people live in your home? Please describe each person

Are you able to financially care for a dog? Monthly bills include insurance ($60/month), food ($30-60/month), heartworm medication ($30/month), and flea and tick preventative ($20/month)?

Describe what a typical day is like for you

How much activity do you expect your dog to get daily?

What type of tasks would you like your dog to perform?

Do you have any specific personality traits you'd like your dog to have?

What energy level would you like your dog to have?

Describe what you hope your service dog will be able to help you accomplish:

What program are you interested in your dog completing? (started service dog, started dog with public access, or fully trained service dog)

Thanks for registering to our event. See you there!

Application Form

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