Application for Training
Please complete all of the required fields
First Name
*
Last Name
*
Date of Birth
*
-
Month
-
Day
Year
Date
Name:
*
First Name
Last Name
Address
*
Street Address
Apt Number
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
Emergency Contact Information
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
-
Area Code
Phone Number
Emergency Contact Email
*
example@example.com
Training Selection
What type of training are you looking for
*
Basic Obedience
Service Dog
If you chose Service Dog. Are you a
Veteran
Civilian
EMS
Law Enforcement
Firefighter
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Military Experience
Branch of Service
Air Force
Army
Coast Guard
Marines
National Guard
Navy
Reserves
Public Service (EMS, Law Enforcement, Firefighter)
What type of Discharge did you have from the Military?
Honorable
Less then Honorable
Other
Do you have a copy of your DD214?
Yes
No
N/A
** You will need to submit your DD214 in Step 2 of the application process **
Upload a copy of your DD214, if you have it available
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Do you have a verifiable medical need for a Service Dog?
Yes
No
Can you obtain a doctor's note that shows you have a medical need for a Service Dog?
Yes
No
** You will need to submit a doctors note in Step 2 of the application process **
Upload a copy of your Doctors Letter, if you have it available
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Do you have the financial resources for the care of a Service Dog? ** This includes veterinarian care and monthly heartworm, flea / tick medication. **
Yes
No
Do you have a dog under the age of 3 that you would like to use as your Service Dog?
Yes
No
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Civilian Service Dog Information
Who will the Service Dog be for?
Adult
Child
If the Service Dog will be for a child, please fill out questions 1 - 4 & 6 - 9. If the Service Dog will be for an adult fill out questions 5 - 9.
1. If the Service Dog is for a child, how old is the child?
Age
2. If the Service Dog is for a child, do they have a physical or developmental disability?
Yes
No
3. If the Service Dog is for a child, what is their physical or developmental disability?
Disability
4. If the Service Dog is for a child, are you ready to safely and effectively control, manage and care for a dog?
Yes
No
5. If the Service Dog is for an adult, do you have a verifiable medical need for a Service Dog?
Yes
No
6. Can you obtain a doctor's note that shows you or your child has a medical need for a Service Dog?
Yes
No
** You will need to submit a doctors note in Step 2 of the application process **
Upload a copy of your Doctor's Letter, if available
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7. Do you have the financial resources for the care of a Service Dog?
Yes
No
** This includes veterinarian care and monthly heartworm, flea / tick medication. **
8. Do you have a dog under the age of 3 that you would like to use as your service dog?
Yes
No
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Dog Information
Your Dog's Name
Your Dog's Age
Approximate
Breed (or best guess)
Is your dog up to date on all of their vaccinations?
Yes
No
Upload a copy of your dog's current vaccination records
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Has your dog been spayed / neutered?
Yes
No
Upload proof of spay/neuter
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Has your dog had any previous obedience classes?
Yes
No
How does your dog react to other dogs?
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Have you every been convicted of a felony?
*
Yes
No
If you are on the sex offenders registry or if you have been convicted of any sort of animal abuse STOP here and do not apply.
If yes, please explain:
Felony Conviction
Who referred you?
If you were given a business card, which dog is on the front of the card?
Signature: Typing in your name signifies that your answers are truthful to the best of your ability.
First & Last Name
Date of Application
-
Month
-
Day
Year
Date
Submit
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