Application for Service Dog

Taking the First Step

In order to have your application reviewed, please fill it out in its entirety.

I have read the entire article about getting a service dog.(Required)

I agree

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are you a Veteran or First Responder?(Required)

Veteran

First Responder

Please specify which branch or department(Required)

Phone

About You

Describe Your Disability(Required)

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

About Your Home

Explain your living arrangements (house, apartment, condo):(Required)

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

Describe your household: Active, Noisy, Quiet, Average: *(Required)

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

Are there other adults or children in the home? List ages and relationship:(Required)

Anyone in the home have any allergies to pets?(Required)

Is everyone in agreement to obtain a Service Dog?(Required)

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?(Required)

Your Experience with Pets

Describe your experience with pets in the past:(Required)

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

Where are these pets now?(Required)

How do you discipline your pets and why?(Required)

Have you ever surrendered a pet and if so why?(Required)

Have you ever had a pet euthanized and if so why?(Required)

Have you ever lost a pet to an accident?(Required)

About the Dog

Where will the dog spend the day?(Required)

Where will the dog spend the night?(Required)

How will you transport the dog? Car, truck, in a kennel, in the back of a pickup, etc.(Required)

Number of hours (average) dog will spend alone?(Required)

Do you agree to keep the dog as an indoor dog?(Required)

When the dog goes out, how do you plan to supervise it? Fenced yard?(Required)

Who will have primary responsibility for this dog's daily care?(Required)

Who will have financial responsibility for this dog?(Required)

Do you agree to provide regular health care by a Licensed Veterinarian?(Required)

What is the maximum amount you are willing to spend on annual veterinarian care?(Required)

What would you do if the costs exceed this amount?(Required)

General Information

Are you willing to take the responsibility for this dog for the next ten to fifteen years?(Required)

What provisions will you make for the dog should you become unable to care for it?(Required)

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

How did you hear about Big Paws Canine Foundation?(Required)

Would you be interested in fostering or training a canine?(Required)

Is there anything else you would like us to know?

PERSONAL REFERENCES:

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

Reference 1

Name(Required)

Phone(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Relationship(Required)

Reference 2

Name(Required)

Phone(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Relationship(Required)

Reference 3

Name(Required)

Phone(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Relationship(Required)

I have read the above and all statements are true.(Required)

I Agree

Electronic Signature(Required)

Additional Comments

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