Dogs On Duty Companion Dog Application

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Universal Screener for Working Dog Requests

Email *

First and Last Name *

Phone Number *

Address (Street) *

City and Zip code *

How long have you lived the current address? *

Tell us about the people that live in your home. Name and age. *

Are you over the age of 18? *

Yes

Are you completing the application for someone under the age of 18? If so, what is the name and age of the child you are applying for? *

If selected, do you consent to a background check? *

Yes

If selected, I consent to a home visit to verify my address and to ensure that placement would be successful. *

Yes

Are you located within 60 miles of O'Fallon Missouri? *

Yes

Driver's License or State ID # (Please indicate which state issued the ID) *

What type of working dog are you looking for? *

ESA/ Comfort (this dog is only allowed in dog friendly places)

Facility/ Therapy (this dog will join you at work )

Service Dog ( This is a task trained dog for individuals with a disability )

If you are applying for a service dog, please list the tasks you are looking for the dog to perform.

If applying for a service dog, please tell us more about your disability. This helps us select the best dog for you.

If you are applying for a facility/ Therapy dog, please tell us where the dog would be working and the type of work you would like the dog to do?

Are you able to financially provide for a dog? (Vet bill, Food, and grooming needs). *

Yes

Are you willing to meet for follow up training? This could be weekly depending on the type of working dog you are applying for. *

Yes

Have you ever trained a dog before? *

Yes

How would you correct a dog for doing something wrong? *

Where will the dog be when it's not with you? *

How many hours a day will the dog be left alone? *

Who will be the primary caregiver for the dog? *

Have you ever given a pet up for adoption or rehome? *

Yes

Other:

How you ever had to ethnize a pet before? *

Yes

Are there other pets in the home? If so, please list all pets and their age. *

If you have other dogs, please tell us about their temperament.

If a dog is placed with you, are you willing to complete fundraisers to help offset the cost of the working dog? *

Yes

Have you applied for a working dog with any other organizations? *

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