DIY Program Application - Veteran K9 LLC

This application does not independently approve or deny you for this program. Please be thorough and fill out ALL parts of the form. Thank you and we hope to work with your 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:*