Application for Service Dog

* Indicates a required field.
I have read the entire article about getting a service dog.*
First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Are you a Veteran or First Responder? *
VeteranFirst Responder

Please specify which branch or department *

Daytime Phone *

Evening Phone

Your Email *

About You
Describe Your Disability: *

Are you requesting a Service Dog be provided or are you requesting that your own dog be trained for a Service Dog?: *

About Your Home
Explain your living arrangements (house, apartment, condo): *

Describe your property (private or public yard, fences and height, pool, stairs, garage, etc.): *

Describe your household: Active, Noisy, Quiet, Average: *

Are there other animals in the home? List breed, age, vaccinations, spayed/neutered, etc.: *

Are there other adults or children in the home? List ages and relationship: *

Anyone in the home have any allergies to pets? *

Is everyone in agreement to obtain a Service Dog? *

If you go away for a few days, or on a vacation, will you take the dog with you or who will take care of the dog? *

Your Experience with Pets

Describe your experience with pets in the past: *

Have you ever owned a dog before? If yes, explain breed, age, training, length of ownership, if pet is still with you. *

Where are these pets now? *

How do you discipline your pets and why? *

Have you ever surrendered a pet and if so why? *

Have you ever had a pet euthanized and if so why?: *

Have you ever lost a pet to an accident?: *

About the Dog

Where will the dog spend the day?: *

Where will the dog spend the night? *

How will you transport the dog? Car, truck, in a kennel, in the back of a pickup, etc.: *

Number of hours (average) dog will spend alone?: *

Do you agree to keep the dog as an indoor dog?: *

When the dog goes out, how do you plan to supervise it? Fenced yard?: *

Who will have primary responsibility for this dog's daily care? *

Who will have financial responsibility for this dog? *

Do you agree to provide regular health care by a Licensed Veterinarian? *

What is the maximum amount you are willing to spend on annual veterinarian care? *

What would you do if the costs exceed this amount? *

General Information

Are you willing to take the responsibility for this dog for the next ten to fifteen years? *

What provisions will you make for the dog should you become unable to care for it? *

Are you willing to let a representative of Big Paws Canine Foundation visit your home by appointment? *

How did you hear about Big Paws Canine Foundation? *

Would you be interested in fostering or training a canine? *

Is there anything else you would like us to know?

PERSONAL REFERENCES:
Please list 3 people that are familiar with you and your pets.

Name, Address, Phone Number and Relationship: *

Name, Address, Phone Number and Relationship: *

Name, Address, Phone Number and Relationship: *

I have read the above and all statements are true.*

Electronic Signature *

Additional Comments