Application for Service Dog Taking the First StepIn order to have your application reviewed, please fill it out in its entirety. * 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