Service Dog Adoption Application

Tallman Family Foundation is a dedicated non-profit organization committed to enhancing the lives of individuals with disabilities and emotional support needs. Through fundraising and public donations, we are able to raise, nurture, and rigorously train assistance dogs. Each dog receives comprehensive care, including basic and advanced training, specialized service training, and complete medical attention encompassing worming, vaccinations, spaying/neutering, and microchipping, prior to placement.

This application is for schools, individuals with disabilities, including children and their legal Parent/Guardian, as well as veterans with documented needs for a service or therapy dog. Examples of tasks needed: DPT, circling, blocking, mobility and stability, emotional support and medical condition alerts and more.

Please remember that the successful integration of a service dog involves a collaborative effort. For families with children, this includes the Parent/Guardian, the child, and the service dog. For veterans and other individuals, it involves the individual and the service dog. We generally utilize Golden Retrievers and Labrador Retrievers due to their suitability for service work.

Only fully completed applications with all required documents will be considered. Anyone over the age of 18 residing in the household may be subject to a background check. We will also need to conduct a home visit to assess the environment and verify the applicant's ability to financially support the yearly average cost of a large dog, which is approximately $1500-$2500.

A non-refundable application processing fee of $35 is required. All fields on the application must be completed for it to be reviewed. Please be aware that submitting an application and completing a phone interview does not guarantee puppy placement.

Please include a copy of a physician's recommendation for a therapy or service dog.

Applications will not be considered if there is a cat present in the home.

Is this application for a child under the age of 18?

YESNO

Name

First NameLast Name

Parent/Guardian Filling out Application if applicable

First NameLast Name

Parent/Guardian 2

First NameLast Name

Relationship to Child?

MotherFatherOther

Date of Birth for person needing service dog

Date

I acknowledge that everyone 18 years and older in the household may undergo a background screening?

YesNo

Anyone else in the household over 18?

YesNo

Other Person?

First NameLast Name

Relationship to person needing service dog?

BrotherSisterOther

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone:

Area CodePhone Number

Cell Phone:

Area CodePhone Number

Primary E-mail to be used for further communication:

How did you hear about the Foundation:

Character reference and phone number:

What is your (or child's if applying for your child) primary diagnosis?

What specific tasks do you think a service dog could do to assist you? Please list in order of importance. (examples: DPT, Mobility, Stability, Circling, Blocking, Emotional Support, & Medical Condition Alerts)

Physician Name:

Physician Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Physician Number:

Area CodePhone Number

Does your physician recommend a Service Dog?

YesNo

Do you or your child in need of a service dog see a ABA Therapist?

YesNo

If yes, can we contact?

YesNo

ABA Therapist Number:

Area CodePhone Number

What type of adaptive equipment is being used use? (wheelchair, crutches, hearing aid)

Are you or your child receiving any current medical treatment?

If applicable, please include a copy of a Physician recommendation for a service/therapy dog.

Browse Files

Are you (or parent/guardian) employed?

YesNo

Employer Name:

Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Employer's Phone Number?

Area CodePhone Number

Can we contact your employer to verify employment?

YesNo

Total household income:

Under $50,000$51,000-100,000$101,000-$150,000$151,000+

Is there a cat in the home?

YesNo

Is there another dog in the home?

YesNo

Do you live in a:

If you rent, Landlord's name?

First NameLast Name

If you rent, what is your Landlord's phone number?

Area CodePhone Number

Are there any restrictions from your landlord or subdivision?

Number of petsSize or weight restrictionsBreed restrictionsNone

Do you have a fully fenced yard?

YesNo

Do you have any of the following?

Underground fenceKennelDog RunN/A

If you don't have a fence, how will you provide exercise for the dog?

Have you or your child been around animals before?

YesNo

Does anyone in your home have allergies to dogs or have asthma?

YesNo

Are you financially prepared to care for a service dog?

YesNo

Are you financially prepared to feed the dog (about $125-$175 a month)?

YesNo

Are you financially prepared to pay vet costs (about $300-500 a year)

YesNo

Are you physically able to bathe the dog?

YesNo

If no, are you financially prepared to pay for grooming?

YesNo

What circumstances would lead you to give up your new dog?

If you had to give up your dog, what would you do with him/her?

If yes, where?

How did you find out about the Tallman Family Foundation?

Anything else we should know?:

I understand that I assume full responsibility for the welfare of this pet from the date of taking the service dog home.

The Tallman Family Foundation reserves the right to deny services to any applicant which doesn't meet the criteria necessary for placement of a service dog or who requires services not trainable within the guidelines of the agency. Submitting an application does not guarantee puppy placement.

If we find any reason that the service dog is not being treated to the standards that we hold ourselves to, we reserve the right to re-home the service dog.

Additionally we may require more information.

My Products

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APPLICATION REQUESTS

Applicant Information

Medical Information

Employment Information

Household/Other Pet Information

Service Contract Information:

Additional Information: