Committed Canine T.E.A.C.H. enrollment application
Street Address Line 2
State / Province
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
Central African Republic
Cocos (Keeling) Islands
Democratic Republic of the Congo
Turkish Republic of Northern Cyprus
Papua New Guinea
Republic of the Congo
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
Tristan da Cunha
Turks and Caicos Islands
United Arab Emirates
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
T.E.A.C.H. course date that would be your first choice.
Second chose for T.E.A.C.H. class date:
Do you (the applicant) have a disability?
Is the applicant a minor child?
If a minor child, please provide a parent/guardian name:
Is the applicant a US military veteran?
Not military, but disabled Police officer
Not military, but disabled Fire Fighter
Have you ever had a Service Dog?
Yes, I currently have a SD
Yes, in the past
Please describe your disability:
Please provide one or more tasks that you would like to train your dog to help mitigate your disability:
Please rate your ability to impose your will on another person.
1 is Worst, 5 is Best
Please rate your agreement with this statement: "To resolve unacceptable behavior, a correction method should be used. To encourage a dog to present new /challenging behaviors, a positive reinforcement method should be used. A balanced approach to training makes sense to me."
1 is Worst, 5 is Best
Are you able to travel to Brownstown, IL three times, for three days, separated by six weeks to attend the course?
Are you able to pay for your lodging and meals during the training classes?
Have you reviewed the Committed Canine website regarding the TEACH program AND the requirements specified for your dog?
Do you have the funds to enroll in the T.E.A.C.H. class?
Do you understand that you need to pay $500 towards the enrollment to hold you spot in the class (it is non-refundable but transferable to a future class), and the remainder ($1500) is due on the first day of the first class?
Do you have a friend or family member who can attend the class with you to offer support?
Do you understand that your dog must be 10 months old (or older) to enroll in the class?
Select all that apply
My dog nips or bites other animals
My dog nips or bites people
My dog seems aggressive towards other animals
My dog seems aggressive towards people
My dog growls at other animals
My dog growls at people
I am a little afraid of my dog's behavior
I am quite afraid of my dog's behavior
I don't think I can handle my dog around distractions
My dog is fearful of new things or people
My dog seems overly shy in some situations
My dog seems highly protective of me or other family members
My dog has evidence of health issues such as hip dysplasia, progressive vision loss, routine ear or skin infections
My dog presents high prey drive towards other animals like cats or squirrels
If I brought my dogs into a room with other dogs, he would whine or bark incessantly
I think my dog might snap at someone who tried to pet him
If you checked any of the above boxes, your dog is not an appropriate candidate for the T.E.A.C.H. class
We recommend that you seek a more suitable dog before proceeding.
Select all that apply
My dog barks quite often
My dog gets fixated on distractions and I find it hard to get his attention
My dog pulls on the leash so strongly that he has pulled me over
My dog lunges at gates or doors or other dogs
My dog runs away
If you selected any of the above, or you can think of similar issues, you may find it challenging to train and maintain your dog's behavior as a high functioning Service Dog.
We suggest that you consider the option of securing a more even-keeled dog, and we would like to speak with you on the phone before admitting you to a T.E.A.C.H. class - to gain more clarification about your dog's behavior.
Provide any additional information about your dog that you would like to share:
Do you understand that you must attend all of the scheduled class dates in order to complete it, and participate in the Public Access Test?
Your dog must be vaccinated against Rabies and Distemper/Parvo to participate in the T.E.A.C.H. class. Please bring a copy (which you may have back) on the first day of class. Alternatively, you may forward copies in email. By hitting Submit, you acknowledge that you must bring your records to the T.E.A.C.H. class and that you have confirmed that your dog is free of external (fleas / ticks) prior to coming to the event.
I understand and agree
I do not agree
Thank you for submitting the enrollment form.
We will contact you shortly regarding the availability in the class session that you selected.
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