Working Dog Application - Veteran K9 LLC

This application is not a approve or deny application but more of an information collecting item. Please be thorough and fill out all parts of form. Thank you and we hope to place you with a dog soon!!

Which type of job do you want your dog trained for? *

Service Dog

Emotional support dog

Therapy Dog

Full Name*

Phone Number*

Address(complete with city and state) *

Email*

Disability needed for Service Dog

For ESA do you have a letter from your doctor?

Yes

No

Breed of dog?*

What are your goals in obtaining training for your dog? What tasks are you looking to have your dog perform?*

Age of person dog is for? *

Date of Birth

Do you rent or own your current residence? *

Rent

Own

What type of residence do you live in?*

Landlord Name (if applicable)

Landlord phone number (if applicable)

Do you have plans to move in the near future?*

Yes

No

If yes, please provide explanation.

What is your primary mode of transportation?*

Number of adults in the house and their relationship to you.*

Number of children in the house *

Have all members of the household agreed to obtaining a service or emotional support dog?*

Yes

No

Do you currently have another pet in the house?*

Yes

No

If you don't currently own a pet, please provide the name and phone # of the vet you wish to use for a new pet. *

Current Pet #1- Name, Age, and Breed

Have you had pets previously?*

Yes

No

How long did you have this pet?*

Why do you no longer have this pet?*

Have you ever been issued a citation or had to reclaim your pet from animal control or the shelter?*

Yes

No

Have you ever given up a pet?*

Yes

No

Veterinarian dog will be going to?*

Veterinarian phone number:*

Veterinarian address:*

In case of emergency do you have a 24/7 pet hospital? *

YES

NO

24/7 Pet hospital phone number:

24/7 Pet hospital address:*

What amount of time will your dog be left alone?*

When you are NOT home, where will your dog be kept?*

When you ARE home, where will your dog be kept?*

Do you plan to crate train your dog?*

If yes, please explain when the dog will be crated. If no, please describe in detail where the dog will be when you are not around.*

How much time would you allow your dog outside unattended?*

Do you have a fenced in yard?*

Yes

No

Under what circumstances would you give up a pet?*

Are you prepared for a potential 15-20 year commitment to a pet?*

Yes

No

Can you afford vet costs that come with owning a pet. Emergency costs?*

Yes

No

Personal reference #1 *

Personal Reference #2 *

Is person with disability a veteran or an immediate relative of a veteran? (IE: sister,brother, father,mother, daughter, son etc) *

Are you a single parent?*

Yes

No

Are you a student? *

Yes

No

Would you be interested in a payment plan?*

Yes

No

We require a deposit to begin the process) Amount of deposit:*