Register of Interest

REGISTER OF INTEREST

submitting this Register of Interest.*

YesNo

Veteran Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityCounty

Post Code

Phone Number

Area CodePhone Number

Email*

example@example.com

Date of Birth*

Military Service*

British MilitaryReservistMerchant Navy

Service Number*

Branch / Unit / Regt. / Corps / Ship*

Marital Status:*

Current Situation*

If currently employed please give details

Where did you hear about Veterans With Dogs?

Please indicate if this Register of Interest is an update to a previous application with VWD*

YesNo

Do you already own a dog?*

YesNo

Please state your primary mental health condition*

Have you received a clinical diagnosis?*

YesNo

Briefly tell us about your mental health difficulties and how these affect day to day living? *

Do you have any physical disabilities?*

YesNo

Do you understand that we do not train or provide dogs for physical disabilities?*

YesNo

Do you require the use of walking aids, such as a stick, a scooter or other aid?*

YesNo

Please tell us about any physical disabilities, especially those that require the use of walking aids

Please give your reasons for needing an assistance dog

Please answer the following:

Do you rely on someone to meet your daily care needs?*

YesNo

Are you able to properly walk a dog - without walking aids - for at least 45 mins a day?*

YesNo

Do you have direct ground floor access to your own enclosed garden or yard area? (Cannot be an upstairs dwelling such as a flat or maisonette, and outdoor space must be secure and not a shared space or communal area)*

YesNo

Do you have the means to transport a dog to the veterinarian?*

YesNo

Do you have any children or dependents under the age of 5 years old?*

YesNo

Are there any other persons living with you, or frequenting your home, with a mental health condition? (including children)*

YesNo

Would an assistance dog accompany you to work?*

YesNo

Have you applied to us previously or currently with any other assistance dog organisation?*

YesNo

How many hours a day would you foresee having to leave an assistance dog alone?*

Owner-Assisted Training

Complete this section only if applying with your own dog.

Key requirements:

Dog must be under three years old at training start point
Suitable size/breed for assistance work
Well-socialised, confident, calm, and friendly
Basic behaviours and manners established

Process:

Attend Meet & Greet day with other applicants
Separate dog assessment arranged post Meet & Greet
Same dog standards apply as VWD-placed dogs
Please read our website FAQs thoroughly before applying with your own dog to avoid disappointment.

Dog Name

Dog Breed

Male or Female?

MaleFemale

Dogs' Date of Birth

Date

Please answer the following about your own dog:

Will your dog be over the age of 3 YEARS in the next 6 months?

YesNo

Have you been the ONLY owner of the dog? (We will need proof of ownership)

YesNo

Do you have breeder details?

YesNo

Is your dog neutered / spayed? (We will need proof of this)

YesNo

Does your dog have any outstanding medical conditions, or on any current medication? (Please give details below in Part 3)

YesNo

Is your dog friendly towards other dogs and people?

YesNo

Is your dog nervous or shy?

YesNo

Does your dog have any behavioural problems?

YesNo

Do you understand that your dog will need to be assessed to determine whether he/she might be suitable for assistance dog training, and that your dog will be subject to the same Standards and Ethics as all other assistance dogs?

YesNo

Use this section to provide any further information you feel we should know at this stage - including further details of disabilities, personal circumstances, and information regarding existing pets.

Data Protection and Declaration

VETERANS WITH DOGS adheres to the Data Protection Act 2018. Your information will be treated confidentially, stored securely, and used solely for providing our services.

By submitting this enquiry, you confirm the accuracy of the information provided and consent to its storage and use by VETERANS WITH DOGS.

I understand and agree that:

This is a Register of Interest, not a full application, and confers no entitlement.
I have read and understood the FAQs on the website.
I consent to eligibility checks.
I have a mental health diagnosis from a qualified clinical professional.
All statements provided are true and factual to the best of my knowledge.
I understad that I must attend a 'Meet & Greet' day in Devon and complete a full application for services.
I will attend residential training in Devon and regular local training sessions.
I am responsible for the estimated £150+ monthly cost of caring for an assistance dog.
A full DBS check will be conducted prior to dog placement.

You will receive a copy of this form for your records upon submission.

I agree with the above declaration*

YesNo

PART 1 Personal Details

PERSONAL NEEDS

Please answer the following:

PART 2 Dog Details

Owner-Assisted Training

PART 3 Other information

CONSENT

Data Protection and Declaration