Hope & Heroes Rescue Program Application

  • Hope & Heroes Rescue Program Application

  •  -
  • Applicant’s Date of Birth*
     - -
  • Is the applicant a veteran?*

  • Household Information & Dog Care

  • Please note that a C4C trainer will be contacting you to set up a time to do an interview in person or virtual (zoom). This interview is mostly to understand your lifestyle, where you live, your activity level,  more about you, etc. Please note that this application is for a COMPANION DOG. Please ensure that this application is filled out to the best of your ability. Any missing information may cause a delay in finding and receiving a companion dog.

  • Are you or anyone you live with allergic to dogs?*
  • Are you or anyone you live with afraid of dogs?*
  • Do you have a job or are retired:*
  • Are there any other animals in the home?*
  • Are the animals (specifically dogs) in your home fixed/neutered?*
  • Once a dog is placed with the applicant, he/she has the responsibility of caring for their companion dog (pet). This requires a financial commitment to the dog’s health and well being. Are you able to feed and care for your dog including but not limited to, food, monthly preventative and veterinary care?*
  • Additional training sessions, training tools, etc. may be required and would be the cost of the recipient. Are these extra costs you are prepared to possibly incur?*
  • Do you have any medical conditions?*
  • Do you have any mental health diagnoses?*
  • Do you take any medication for mental health diagnoses?*
  • Do these diagnoses/medications impact your life in any way?*
  • Would any of your medical conditions, mental health diagnoses or anything related to your physical/mental health impact your ability to take care of a companion dog?*
  • When applying for a companion dog, you have the option to pay for the initial training, and care of the dog while it is at the Canines for Change Facility. If you do not pay for the training/care then we need a business sponsor to help with this cost. The cost is $2,500.*
  • A companion dog has been rescued from a shelter/non profit locally and is matched with their “person”. Do you understand that Canines for Change and any organization working with Canines for Change are not liable for any unknown medical conditions that may come up in the lifetime of the companion dog?*

  • Disclaimer:

    A completed application does not guarantee a companion dog through Canines for Change. Canines for Change and any organization working with Canines for Change, reserves the right to deny any applicant for a companion dog for any reason.

  • Date:*
     / /
  • Should be Empty: