Service Dog Application

Service Dog Application

Please read the following requirements before filling out your application. Incomplete applications will not be reviewed.
- Submit a $50 (+tax/fees, non-refundable) application processing fee. The application fee must be paid before your application will be reviewed.
- You will be expected to maintain your dog’s appearance, health and manners as well as continue to improve your skills as a handler.
- Your Service Dog will not be off leash in public (with the exception of a disability that requires the dog to do tasks off-leash).
- You are responsible for all maintenance, boarding, health and training with your service dog. Including board and train programs and at home programs.
- Your home must be a safe enviornment for a dog.
- You must pass The Public Access Test administered by your trainer and will be tested annually.
- There is a $175 equiment fee for vest rental, cleaning costs, and ID packages. You must maintain and display identification on your dog for public access.
- All dogs in the program must be up to date on all vaccinations, flea/tick prevention, and deworming, as necessary.
- You will be responsible for any damage caused by your dog.
- Your Service Dog will not go to dog parks as they are proven to be unsafe and unsanitary at any time during your training. *Special Conditions Apply*
- If your dog is diagnosed with any communicable condition (fleas, ticks, worms, illness) you must notify trainers immediately.
- We will keep your information and entire application confidential. We do not release documents to any other organization for any reason.
- Your photos and application will become the property of Service Dogs Of New Mexico and The Academy of Canine Excellence.
- There are no refunds for any services at any time. Teams who do not meet minimum standards can be removed from the program at any time.
- You must attend a 1-hour Orientation ($150 non-refundable) to go over ADA law, rights, responsibilities and how to care for your Service Dog.
Client Information
Please select one or more.

ChildAdultVeteran/Active DutyEMT/Fire Rescue/Police
Client name

First NameLast Name
Birth date

MonthDayYear
Date
Email
example@example.com
Phone number
Please enter a valid phone number.
Emergency Contact

First NameLast Name
Emergency Contact Phone #
Please enter a valid phone number.
How many people live in the home (including you)?
Please list all members of the household (age and relationship to you)
How many animals (dogs & cats) live in the home?
Do you have any other pets? Please list.
Do you have a dog? (IMPORTANT: If you do not have a dog please do not go adopt/purchase one. Our staff is specially trained to assist in the placement of the service prospects.)

Yes, a puppy. Under 4 monthsYes, a puppy. Under 1 yearYes, a family pet I would like to train.No, I will select my own dog.No, I would like assistance finding the right dog.
Do you have reliable transportation to and from lessons?

Yes, I have a reliable vehicle.No, at times travel is difficult.I use public transportationI use Uber/Lyft
Disability Details

If not listed please describe below.
What type of disability does the applicant have?

Mental healthMobility/physicalSeizures/EpilepsyDiabetiesCardiac ConditionEDS/POTSAutism Spectrum DisorderPTSDAnxiety DisordersDepressionCognitive ConditionsDeaf/hearing lossAcquired brain injuryMedical/chronic illnessBi-Polar 1 or 2Other
Detailed explanation of the disability
How would a service dog help with your disability? In your opinion.
Expected duration of disability

Permanent disability with ongoing (chronic or episodic) symptoms that significantly impact one or more areas of the applicants quality of life.Undiagnosed at this time.Symptoms are mild and resolve with little to no assistance.
Disability-Related Information & Limitations

Training Criteria

	No Issues	Mild Impact	Moderate Impact	Severe Impact	Uncertain
Listening
Speaking
Hand/ Arm Function
Completing Assignments/ Practices
Social situations
Participating in Group Activities

Cognitive Skills and Abilities

	No Issues	Mild Impact	Moderate Impact	Severe Impact	Uncertain
Concentration/Attention
Executive functioning (planning, organizing, problem-solving, sequencing, time management)
Information Processing
Long-term memory (recall/retrieve stored information)
Short-term memory

Physical Activity Intolerance

	No Issues	Mild Impact	Moderate Impact	Severe Impact	Uncertain
Gross motor: Reaching
Gross motor: Bending
Fine motor/manual dexterity
Climbing (stairs)
Walking
Sitting for Sustained Periods
Standing for Sustained Periods

Socio-emotional

	No Issues	Mild Impact	Moderate Impact	Severe Impact	Uncertain
Fatigue
Managing Stress
Mood
Social Interactions
Attending Class
Speech

You can add any additional limitation(s) related to your ability to participate in training and attend lessons? Please provide any further information.
Medical Professional Information
We understand doctors appointments can be hard to schedule and that it may take time to collect the nessicary documents.

Medical documentation must be presented before graduation from the training programs.

We accept diagnosis sheet, mychart print out, a letter from a therapist/doctor, a perscription/reccomendation for an ESA or service animal, and much more.

Please upload available documents below.
Medical File Upload

Cancelof
Name of certified medical professional

First NameLast Name
Profession title
Phone Number
Please enter a valid phone number.
Email
example@example.com
Dog Information
What type of home do you live in? (Apartment, House, Condo, etc)
Do you have a yard?
Where will your dog sleep at night?
Where will your dog be during the day (if not with you)?
How many hours a day are you away from home on average (school/work)?
Describe some activities you like to do on a weekly basis. (Hiking, sports, art, watching tv, church)
Describe a life in the day of your dog.
Please list the places you would like your dog to be trained to attend:
Ideal Dog Traits

Small Size - Under 30lbsMedium Size - 30 to 50lbsLarge Size - 50 to 100lbsXL Size - 100+lbsShort hair (Ex: Lab)Medium/Long Hair (Ex:Golden)Hypo-Allergenic (Ex:Poodle)Don't care about hairSnugglyActiveFetchingHiking BuddyMale Dogs OnlyFemale Dogs OnlyMale or FemaleMale PreferedFemale PreferedLazy DogGood with catsGood with Children
If we are placing a dog with you for this program, please be aware there will be an adoption fee of between $500 to $5000 depending on the dog and requirements needed. Purebred dogs and puppies often cost more. We do use rescue dogs when available and are committed to finding the best fit and most effective dog to help with your disability. Some tasks (psychiatric, autisum support, seizures, diabetes, scent work) are all best trained from puppyhood.

Dog placement can take anywhere between 2 weeks & 6 months on average.
Are you able to care for and train a puppy/young dog? (Puppies typically have a higher graduation rate and have shown to do better in task related sensitivity. Puppies however...are puppies and are not always a match for every home.)

Yes, I want a puppy/young dog.No, I have a dog already.No, I would like an older/rescue/shelter dog.
Would you like to work with an older dog/rescue/shelter dog? (Please be aware that many older/rescue/shelter dogs will come with their own "baggage" and may need additional training before acceptance into the service program.)

No, please place a puppy/young dog with me.Yes, I understand older/rescue/shelter dogs may have additional training needed and I'm willing to work with one.No, I have a dog already.
If you have a dog you would like to have tested for program entry please fill out the following forms and wait for a trainer to contact you for scheduling.

All dogs must be healthy and have current vaccinations.

Scheduling can take 2 to 4 weeks.

Health Certification : www.tinyurl.com/acevax

Owner Info: www.tinyurl.com/acepet

Speed up the process: Pre-Paying for Evaluation

Pay Application Fee: click here
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Signature*

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Service Dog Application

Client Information

Disability Details

Disability-Related Information & Limitations

Medical Professional Information

Dog Information