National Association for Canine Detection Service Dog Application

National Association for Canine Detection Service Dog Application
Full Name
Date of Birth

MonthDayYear
Date
Address
Phone Number
Email Address
example@example.com
Preferred Method of Contact
2. Military or First Responder Status
Status
Branch of Service / Agency
Rank (if applicable)
Dates of Service

MonthDayYear
Date
Type of Discharge
Currently receiving VA or agency treatment?
Facility Name/Contact Info (if yes)
3. Disability & Service Dog Needs
Diagnosis / Reason
How would a service dog help you?
Do you have experience with dogs?
Are you working with any trainers/programs?
4. Lifestyle & Home Environment
Residence Type
Home Ownership
Is your home suitable for a dog?
Other pets at home?
Allergies to dogs?
Email: Nacdetection@gmail.com Address 3631 Ridge Road, Perkasie, PA 18944
Service Dog Application
Support system available?
Can you commit to daily care and training?
Willing to travel for training?
Agree to a home visit/interview?
Signature

Clear
Date

MonthDayYear
Date
Email: Nacdetection@gmail.com Address 3631 Ridge Road, Perkasie, PA 18944
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