TEAM INFORMATION
Veteran Name
*
First Name
Last Name
Service Dog Information
*
Dog Name
PAD ID #
SERVICE DOG TASKS / SKILLS
My dog is completing the tasks that I need it for:
*
Yes
No
If you answered no, please tell us what tasks your dog is struggling with, and a trainer will contact you to help you with these tasks:
My dog completes the following tasks for me (check the the tasks you need/use): (Check all that apply)
*
Touch/Nudge
Check-In
Interrupt Night Terrors
Fore / Aft (Front / Back)
Interrupt Anxiety
Ground
Interrupt Road Rage
Take Me Out
Interrupt Crying
Medication Reminder
Other
What symptoms/situations does your dog's presence help manage? (Check all that apply)
*
Anxiety
Flashbacks
Social Isolation
Depression
Public Interactions
Night Terrors
Extended Family Relations
Traveling Overnight
Immediate Family Relations
Workplace / School Interactions
Medical Appointments
Other
SERVICE DOG HEALTH
I was able to get health insurance for my dog through the VA:
*
Yes
No
In Progress
What is this?
Primary VA Location
*
My dog is up to date on all of the following vaccinations and flea/tick/heartworm medication:
*
Rabies
Distemper
Leptospirosis
Bordatella
Lymes
Canine Influenza
4DX Test (Heartworm/Tick Diseases)
Flea & Tick Preventative
Heartworm Preventative
Veterinary Clinic Name
*
Veterinary Clinic Phone Number
*
My Dog's Current Weight is:
*
Use the weight from the last time you or your veterinarian weighed your dog.
My Dog's Ideal Weight Is:
*
This can be found on your initial contracts with PAD
How much unvested activity (play/walk/etc.) does your dog get each day?
*
Less than 1 hour
1-2 hours
2-3 hours
What is your dog's favorite playtime activity?
*
My dog is having health issues:
*
Yes
No
If your dog is having health issues, please tell us what health issues your dog is struggling with:
PAD is REQUIRED to physically see your dog a minimum of once per year, as set for by the Assistance Dogs International (ADI) required standards. How would you like to present your dog to a PAD staff member?
*
In Person
Video Chat (we will send you a link)
At a PAD Event
A PAD Staff has already viewed my dog this year (2026)
If someone from PAD has viewed your dog in 2026, which staff member was it so that we can update our records:
MISCELLANEOUS OPPORTUNITIES
ADI provides highly secure, digital ID cards that you can have on your smartphone. Are you interested in getting set up with a digital ID?
*
Yes
No
I already have it
If yes, what email would you like the Digital ID invitation to be sent to?
I would like someone from PAD to contact me about the following training opportunities (check all that apply):
Two Day Refresher Clinics (Quarterly at PAD, Basic Obedience, Advanced Obedience, CGC Skills, Public Access Skills & Troubleshooting)
One Day Clinic (Monthly at PAD, Basic Obedience, Advanced Obedience, CGC Skills, Public Access Skills & Lunch & Troubleshooting)
Airport Training (at MSP Airport)
I am interested in volunteering for the following events/projects for PAD: (volunteering is not required, but is always appreciated - check all that apply):
Fundraising (individual fundraising in your area, selling raffle tickets, gathering items for silent auctions, prizes, etc.)
Event Attendance (event booths, mingling with the crowd, answering questions, etc.)
Speaking / Interviews (at events, for newspapers, podcasts, radio, etc.)
Class Mentor (must be with your current dog for one year)
Building Maintenance / Projects
Have you ever been denied public access with your service dog?
*
Yes
No
If yes, where did it happen and was the situation resolved?
CURRENT CONTACT INFORMATION:
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
Signature
*
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