Service Dog Application 

  • Service Dog Application

  • Thin Line Service Dogs(TLSD) serves first responders and veterans with a qualifying disability.  We are unable to serve you if your needs are outside of our predefined range of clientele.  TLSD does not descriminate on the basis of race, color, creed, national origin, sex, age, religion, marital status, sexual orientation, gender identity, or expression, veteran or first responder status, HIV/AIDS status, physical or mental disability.  

    Your packet contains all of the following materials:

    Service Dog Application

    • Completed application to include the medical information 
    • Physician Statement of Disability
    • Consent/Non-Consent for Medical Treatment Form
    • Photo/Video Release Form
    • General Release of Liability 
    • Applicants that are first responders (fire, police, dispatch, sheriff, etc.) should provide disability papers or current ID badge
    • DD214 Form that contains separation for veterans (please black out SS #) or a photocopy (front and back) of military ID card for active duty military
    • A Photo of yourself

  • Photo/Video Release

  • About Thin Line Service Dogs

    Thin Line is a 501(c)(3) nonprofit with a mission to provide trained service dogs to disabled first responders and veterans at no cost.

  • Dear Applicant:

    Thank you for your interest in obtaining a service dog from Thin Line Service Dogs, Inc. Enclosed is an application packet that must be completed in its entirety before we will process your application. Incomplete application packets will not be considered.

  • Part I: Personal Information

    This section covers you name, address, email, phone, etc.
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  • Have you ever been convicted of a felony?*
  • Are there currently any felony charges pending against you?*
  • Have you ever been charged or attended a mandated class due to the charge of a DUI or DUID?*

  • Part II: Family/Living Situation

    This sections identifies your living status.
  • What is your marital status?*
  • In what type of residence do you reside?*

  • Do you live in a single story home?*
  • Are there stairs that lead up to your residence?*
  • Whom do you live with?*

  • Do you have any children (foster, adopted and step children, included)?*
  • Are there any other family members in you home with disabilities?*
  • Do you have a yard?*
  • If "Yes" to the above, is it fenced?
  • Is there an in-ground pool in your yard?*

  • Part III: Demographic Information

    We are gathering important demographic information to track progress of inclusivity and diversity measures being taken within our organization. To the extent you are comfortable, please select the options that best reflect how you identify.
  • Gender:
  • Ethnicity:

  • Part VI: Employment

  • What is your current employment status?*

  • What is your primary source of income?*

  • Do you work outside of the home?*
  • Are you regularly exposed to paints, fumes, chemicals, or other potential toxins where you work?*
  • Is you work location stationary (ex. office/desk job, classroom)?*

  • Part V: Pets

    This section covers your current and past pets, as well as, knowledge of care and veterinarian.
  • Do you currently have any pets in your home?*
  • Have you ever had a dog before?*
  • Is anyone in your home allergic to animals*
  • Does anyone in your home have a fear of dogs?*
  • Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*
  • If you qualify for a service dog, are you limited to a specific gender?*

  • Part VI: Public Servant

    Thank you for your service! This section covers where, how long and involvement in your community.
  • Are you a military veteran?*
  • If "Yes" to the above, in which branch of the military did you serve?
  • Did you serve in combat?*
  • Have you ever worked as a public servant in any of the following positions?*

  • Part V: Medical History

    This section covers your medical information, including and not limited to date of diagnosis, treatment information, physician information and release to contact clinician.
  • Was your disability job related?*
  • Are you on any prescription medication?*
  • Do you use any "recreational" drugs?*
  • Is your disability considered to be progressive?*
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  • Do you give TLSD permission to contact your current health care provider regarding your condition?*
  • Have you discussed the aide of a service dog with your health care provider(s)?*
  • What type of service dog are you requesting? (Please note that TLSD does not train hearing, guide, alert or autism dogs)*
  • Do you currently use any of the following assistive/adaptive devices?*
  • Please indicate which of the following activities are limited by your disability:*

  • Do you currently experience any of the following?*
  • Is your voice:*
  • Rows
  • Do you:*

  • Do you have a valid driver's license?*
  • Do you currently operate a motor vehicle?*

  • Please describe how you will handle the following areas of dog care:

  • Part IV: Financials

    This section is to establish the financial stability to provide the upkeep of the service dog.
  • It is estimated that it cost approximately $1,500 annually for basic care. Are you financially able to provide that?*
  • TLSD recommends pet insurance on all our dogs. This would be an additional expense. Is this insurance you are interested in?*
    • By clicking the submit button, I agree to Thin Line Service Dogs Inc. placement process, will undergo a homecheck, and interview at the discretion of Thin Line Service Dogs, Inc. 
    • By clicking the submit button, I understand Thin Line Service Dogs, Inc. will check my references including veterinary and personal. 
    • By clicking the submit button, I understand that if I am paired with a service dog that Thin Line Service Dogs, Inc., will have the right to reclaim the dog at any time and immediately due to my inability to care or treat the dog properly.  
    • By clicking the submit button, I understand there if for any reason I can not care for the dog, I will return to Thin Line Service Dogs, Inc., immediately. 
    • By clicking the submit button, I agree to indemnify and hold harmless Thin Line Service Dogs, Inc. against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my service dog, once placement has been completed.  
    • By clicking the submit button, I understand that if a service dog is placed with me, it is my responsiblity to travel to WV for two weeks of training and will be at my own expense.  
    • By clicking the submit button, I give Thin Line Service Dogs, Inc permission to contact my medical provider(s) to seek information soley on the premises of service dog placement and will keep my medical information confidential.
    • By clicking the submit button, I verify all of the above information is true and accurate.  

     

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