Which type of job do you want your dog trained for?
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Service dog
Esa
Therapy
Other
Full Name
*
Phone Number
*
Address(complete with city and state)
*
Email
*
example@example.com
Disability needed for Service Dog
Breed of dog?
What are your goals in obtaining training for your dog? What tasks are you looking to have your dog perform?
Age of person dog is for?
Do you rent or own your current residence?
Rent
Own
Other
What type of residence do you live in?
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Landlord Name (if applicable)
Landlord phone number (if applicable)
Do you have plans to move in the near
If yes, please provide explanation.
Number of adults in the house and their relationship to you.
Number of children in the house
*
If you don't currently own a pet, please provide the name and phone # of the vet you wish to use for a new pet.
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Current Pet #1 Name, Age, and Breed
How long did you have this pet?
*
Why do you no longer have this pet?
Veterinarian dog will be going to?
Have you ever been issued a citation or had to reclaim your pet from animal control or law enforcement?
Yes
No
Veterinarian phone number
*
Veterinarian address
*
24/7 Pet hospital phone number
24/7 Pet hospital address
What amount of time will your dog be left alone?
When you are NOT home, where will your dog be kept?
When you ARE home, where will your dog be kept?
Do you plan to crate train your dog?
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If yes, please explain when the dog will be crated. If no, please describe in detail where the dog will be when you are not around.
How much time would you allow your dog outside unattended?
Under what circumstances would you give up a pet?
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None
Other
Can you afford vet costs that come with owning a pet. Emergency costs?
Yes
No
Are you prepared for a potential 15-20 year?
Yes
No
Personal reference #1
Is person with disability a veteran or animmediate relative of a veteran? (IE: sister, ,brother, father,mother, daughter, son etc)
*
Father
Mother
Brother
Sister
We require a deposit to begin the process) Are you able to put a $1000 deposit down?
*
Submit
Should be Empty: