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COLLAB Dog Training: Owner-Trained Service Dog Application (In-Person Program) Form

Section 1: Applicant Information - I am submitting this application for:

Myself

Someone else

Full Name of who the service dog is for:

Please fill out this field.

Full name of handler (if different than above)

Please fill out this field.

Date of Birth:

Preferred Pronouns:

Please fill out this field.

Phone Number:

Please enter a phone number.

Email Address

Please enter a valid email address.

Home Address:

Please fill out this field.

How did you hear about COLLAB Dog Training?

Google Search

YouTube

Instagram

Word of Mouth

Veterinarian Referral

Other

Please fill out this field.

Date of Onset:

Please fill out this field.

Is your medical team aware and supportive of you adding a service dog to your treatment plan?

Yes

Unsure

Note: A letter from your medical provider will be required to confirm disability status.

Please check this box to continue.

Section 3: Dog Information - Do you currently have a dog you want to train as a service dog?

Yes

Considering

Dog’s Name:

Please fill out this field.

Breed or mix (if known, otherwise best guess is ok)

Please fill out this field.

Age / Date of Birth:

Please fill out this field.

Sex & Reproductive Status (intact, neutered, spayed):

Please fill out this field.

Weight:

Please fill out this field.

Microchip/Tattoo/License #:

Please fill out this field.

Date of Neuter/Spay (if applicable):

Please fill out this field.

Vet Clinic Name:

Please fill out this field.

Does your dog have any current or past medical conditions?

Yes

Vet’s Email Address (we will reach out to your vet for confirmation of health)

Please fill out this field.

Has your dog seen a veterinarian recently?

Yes

Scheduled soon

Please fill out this field.

Emergency Contact for Your Dog (Name, Address, Phone):

Please fill out this field.

Are there any stressors or triggers in your home or routine?

Yes

Please fill out this field.

Do you think these traits are helping or hindering your training goals?

Yes

Are there natural behaviors you’re struggling to manage at home or in public?

Yes

I understand that participating in training is not a guarantee my dog will be a service dog.

Please check this box to continue.