LGF Field Intake
Let’s Talk About Your Dog
Who we’re talking to when your dog inevitably ignores us instead?
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
What line of clotho are you cut from?
*
Veteran
Civilian
So… what did your dog do that brought you here?
*
My dog listens selectively (snacks required)
My dog pulls like they’re training for the Olympics
My dog has strong opinions about everything outside
My dog is actually fine, I just need help
Other
If yes does your dog perform a specific task for you?
Yes
No
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Age of person needing service dog:
*
Everyday vehicle size:
*
Large
Medium
Small
Other
Do you rent or own?
*
Rent
Own
Other
Housing type:
Example: apartment etc
Do you have a fenced in yard?
*
Yes
No
Other
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*Service Dogs/Therapy Dogs ONLY*
Task Training
Task 1 Description:
Task 2 Description:
Task 3 Description:
Special Equipment (At Cost Only)
Yes
No
Equipment Description & Cost:
Equipment Total:
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Payment Plan Options
Full Payment Upfront
Monthly Payment Plan
Disclaimer:
I understand that the service dog provided to me by the Loyal Guardian Foundation’s Veteran K9 Program has been trained to perform specific tasks related to my needs. I acknowledge that ongoing care, handling, and training maintenance are my responsibility.I release the Loyal Guardian Foundation, its staff, volunteers, and affiliates from all liability or claims arising from the behavior, health, or performance of the dog once it has been placed in my care.I understand that the Loyal Guardian Foundation cannot guarantee that this service dog will be recognized by all establishments or individuals and that it is my responsibility to follow all ADA guidelines and local regulations pertaining to service animals.
Signature
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