Service Dog Application Form
Please fill in the information below to the best of your knowledge, this application does not guarantee selection or approval.
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Membership Status for the Association
*
Active Member
Not Active Member
Medical Information
Description of service-related disability:
*
Verifiable medial need for a service dog:
*
Browse Files
Cancel
of
Any additional health concerns relevant to caring for a dog:
*
Home Environment
Type of Residence - (House, Apartment, Condo, Etc)
*
Do you have other pets:
*
Yes
No
How many people live with you:
*
Describe your living space and the surrounding area of your home:
*
Experience with Dogs:
Have you ever owned a dog:
*
Yes
No
On a scale of 1-10, 1 being not comfortable and 10 being very comfortable, how comfortable are you with dogs:
*
Do you have any specific concerns about working with a dog:
*
Service Dog Needs
What specific tasks do you need assistance with:
*
Do you have a preference for a specific breed or temperament:
*
Lifestyle Information
Please describe your daily routine:
*
What kind of work or school commitments do you have:
*
What hobbies or activities do you participate in regularly:
*
Support System
Availability of family or friends to assist with dog care if needed:
*
Training Commitement
Can you attend a 2-3 training sessions:
*
Yes
No
Can you commit to ongoing training and care:
*
Yes
No
Travel Arrangements:
Are you able to procure travel to the K9 training Facility:
*
Yes
No
Additional Information
Type a question
Please share any additional information that you deem relevant to your application:
*
Acknowledgments:
Please acknowledge that the Association may not be able to train a dog for your specific need by checking yes below:
*
Yes
No
Read and Agree to the Terms and Conditions
*
Agree
Disagree
Does the Association have your permission to conduct necessary background checks or further assesments:
*
Yes
No
Please agree to be contacted by phone, mail, email and text in regards to the 10th Mountain Division Association or any of its programs.
*
Yes
Please verify that you are human
*
Click Here to Submit Your Application
Should be Empty: