TRAINED DOG APPLICATION

TRAINED DOG APPLICATION
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Your AGE:
Your GENDER:
Your PROFESSION:
Or type student, retired or minor child etc... if applicable.
Is this dog going to be partnered with a person with a disability?

Yes. I am that person.Yes. I am representing that person who is a MINOR CHILD.Yes. I am representing that person who is an ADULT.No. This dog will not be partnered with a person with a disability.
If you are filling out this application for someone other than yourself, please list the name of the person who is applying for a TRAINED DOG:
List the number of adults and minor children in the home where this dog will live:
List the number, age and species of other pets in the house where this dog will live:
Provide the living situation where this dog will reside:

Single family home - ownedSingle family home - rentedCondominium/Apartment - owned (pets allowed policy)Condo/Apartment - owned (no pets - Service Dogs permitted)Condo/Apartment - rented (pets allowed policy)Condo/Apartment - rented (no pets - Service Dogs permitted)Other
How will this dog be exercised outdoors (select all that apply):

Let out in secure fenced yardLet out in partial fenced, or unsecured yardWalked on leashRun free in public areaRun free in Dog ParkOther
Have you owned a dog before?

Yes, but only as a childYes, and I currently own a dogYes, as an adult but I don't currently own a dogNo, I have never owned a dog before
Have you trained a dog before?

No, neverA pet over 5 years agoA pet in the past 5 yearsA previous Service DogA Service Dog that I still use
What type of TRAINED DOG are you seeking?

Well mannered COMPANION / pet for an individualWell mannered COMPANION / pet for a familyTHERAPY DOG used for volunteer workPROFESSIONAL level THERAPY DOG (will go to a workplace)EMOTIONAL SUPPORT DOG - this is not a Service Dog (no specific trained tasks, not ADA compliant as a Service Dog, few public access rights)Dog I can SELF TRAIN as an ADA compliant SERVICE DOGDog I can enroll in Professionally Guided-Owner Trained SERVICE DOG programDog I can enroll in a Custom Training / fully trained SERVICE DOGOther
Are you, or the individual you are representing, a DISABLED US MILITARY VETERAN?

YesNo
Will this dog be partnered with and provide assistance to a PERSON WITH A DISABILITY?

YesNoDon't know
SKIP this question if you are not seeking a SERVICE DOG. Select any of the following that apply to your needs for a TRAINED DOG:

Helps to mitigate a psychiatric disability (PTSD, Panic/Anxiety, Clinical depression etc...)Helps to mitigate mobility / balance issuesPhysical disability supportWheelchair assistanceRetrieve itemAutism support physicalAutism support emotionalSeizure / Shift-from-Normal episode RESPONSESeizure / Shift-from-Normal episode ALERTDiabetic alertAllergen alertOther
Are you interested in having this dog enrolled in any of the following programs?

Committed Canine T.E.A.C.H. (professionally guided -owner trained program)Committed Canine Custom Service Dog TrainingCommitted Canine Professional Therapy Dog trainingNone of the above, but I would like training assistance for the dogNone of the above
Do you have the funds to purchase food for your dog (approximately $10-$50/month)

YesNoDon't know
Do you have the funds to purchase flea/tick preventative (approx. $4 - $20/month)

YesNoDon't know
Do you have the funds to purchase heartworm preventative (approx. $5 - $15/month)

YesNoI'm not sure
Do you have the funds to purchase annual veterinary care for your dog (approx. $50 - $400 / yr)

YesNoI'm not sure
Do you have the wherewithal (capacity) to maintain a dog on a daily basis, including two to four exercise periods, regularly scheduled feeding, grooming, routine training?

YesNoNot sureI cannot do that, but I have help and the dog will receive proper care
If you selected "not sure" or "I have help" in the answer above, please describe your situation further including how the dog's daily care will be addressed.
If you know the name of the DOG IN TRAINING are you interested in, please provide it here?
What interests you in the TRAINED DOG that is currently available?
Please provide any additional information you may want to share about your needs for a TRAINED DOG:
Thank you for taking the time to submit an application for a TRAINED DOG from Committed Canine.

We attempt to get back to you within 48 hours. If you don't hear back from us by then, please check your SPAM or JUNK email folders as our email often ends up there the first time we sent to a new account.

You may also email us at: DarnFar.Ranch@hotmail.com
How did you hear about us?*
Should be Empty: