Facility Dog Interest Form

Facility Dog Interest Form

Please allow 10 minutes to complete this form.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Facility Information
Facility Name*
Facility Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please describe the patient/client population to be served by a Facility Dog*
Facility Dogs, like Assistance Dogs, are specially trained to perform tasks. Successful applications will have identified at least three tasks that would benefit the population served, which extends beyond the prescence of the dog.
How do you envision a Facility Dog being of benefit to the population you serve? *
Can Do Canines places Facilty Dogs free of charge. Following placement, recipients of a Facility Dog will assume the costs associated with the care of the dog. This includes food, supplies, and routine or emergency veterinary care. Successful applicants will have determined funding and identified who will be responsible for the costs of care.

Please note there is a $50 nonrefundable application free.
How will the Facility Dog Program be funded? *
Facility Dogs are not guaranteed access rights to public or private facilities, therefore a Facility Dog Program must be approved by the entity overseeing the facility.
Have you received approval for a Facility Dog Program?*

YesNoIn process
Please upload a letter of approval from your facility.

You may provide this letter at a later date.
Cancelof
A Facility Dog must have a primary handler identified prior to placement. The Facility Dog typically lives with the primary handler and is with this handler for at least 50% of their working hours. One to two additional handlers may also utilize the Facility Dog and/or provide backup care. The dog may not work more than 40 hours per week.
Has a Facility Dog handler been selected?*

YesNoIn process
How did you hear about Can Do Canines?
Please list any questions you have prior to submitting an application for a Facility Dog.
Should be Empty:

Facility Dog Interest Form

Facility Information