Service Dog Training Application

Name

Street Address

Your Email

Preferred method of contact

Parent/ Guardian Name(s)

School Information

(if applicable)

School Street Address

Have you ever raised a puppy before?
YesNo

Have you ever raised a puppy with the intent to become a service dog?
YesNo

If yes please explain:

Lifestyle Information

(to be completed by parent or guardian if under 18)

How many hours a week are you working or in school?

You currently reside in a:

HouseApartmentDuplexOther

If Other, please describe

Your residency currently has a

Fenced YardEnclosed AreaOther

If Other, please describe

With whom do you live?

Please list all other people living in your home.

Include: Name, Relation, Sex – M or F, Date of Birth

Have you ever owned a dog?
YesNo

Do you have any current pets?
YesNo

Include: Breed, Name, Age, Sex

Is anyone in your home allergic to dogs or pet dander?
YesNo

If so, describe:

Describe your typical daily schedule.

When do you get out of bed in the morning?

When do you retire in the evening?

On a scale of 1-5 (1 = low, 5= high), describe your:

How much exercise, on average, do you think a dog needs per day?

Describe your definition of exercise.

Additional Service Dog Help

Who will help you with the dog’s care if you are sick and cannot get outside:

Proximity to your home:

Do you have any concerns regarding owning a service dog?

YesNo

If so, describe.

Do you agree to participate in all instructions given by trainers with consistancy?

YesNo

Are you willing to participate in ongoing training sessions after receiving a service dog?

YesNo

Will your family accept a trained dog as an equal partner in your house?

YesNo

The information on this application is correct to the best of my knowledge.

Relationship to Applicant: