Career Change Application Request

KSDS Career Change Dog Application
KSDS Assistance Dogs, Inc.
120 W 7th St.
Washington, KS 66968

785-325-2256
Fax: 785-325-2258
snutsch@ksds.org
KSDS Assistance Dogs, Inc. is a non-profit organization that trains and places guide dogs for the blind and visually impaired, service dogs for the physically disabled, and facility dogs to work alongside professional educators. The dogs used for the program are screened and tested on their physical qualities, trainability, how well they adjust to new environments, and temperament. Some dogs will not pass these tests, so they are released and available for adoption. Other dogs available for adoption can include a retired guide, service, or facility dog. These dogs are in need of a stable and loving home.

To place your name on file as being interested in adopting a released or career change dog, please complete the following so we can find the best match for you and the dog.

Note: By completing this application you acknowledge that if a career change dog is placed with you / your family they will NEVER work as a therapy dog, emotional support animal, or in any other capacity. You acknowledge they will ONLY be a house pet who will never receive public access rights of any kind.
Check your dog preferences. *

Black Labrador Yellow Labrador Golden Retriever Male Female Released Retired Calm Temperment Active / Energetic No Preference
List any physical qualities you will NOT accept.
Applicant Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone *
Work Phone
Mobile Phone
E-mail *
Number of family members in the household. *
Number of children in the household. *
If there are other pets in the household, describe them.
Reference Name *
Reference Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Reference Phone *
Veterinarian Name *
Veterinarian Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Veterinarian Phone *
Describe why you would like to adopt a Career Change dog from KSDS Assistance Dogs, Inc. Include information about yourself, family, environment, hobbies, and activities. *
By completing this application you acknowledge that if a career change dog is placed with you / your family they will NEVER work as a therapy dog, emotional support animal, or in any other capacity. You acknowledge they will ONLY be a house pet who will never receive public access rights of any kind. *

I acknowledge the above statement. I also understand that failure to abide by the above requirements could lead to forfeiture of the career change dog back to KSDS.
Should be Empty:

KSDS Career Change Dog Application