Service Dog Application
When filling out this form, answer questions for the person who will be using the service dog, referred to as APPLICANT, unless otherwise specified.
Applicant's First and Last Name (Who will be using the service dog?)
Applicant's (the person using the service dog) Date Of Birth
Height (In Inches)
Weight (In Pounds)
Where are you in the process of obtaining a service dog?
RESEARCHING CONCEPT I am researching if this is something that will help us and have some questions.
COMMITTED, RESEARCHING ORGANIZATIONS & FEASIBILITY We have been recommended by a professional to get a service dog.
COMMITTED We are definitely committed to moving forward to obtain a service dog, including ready to provide medical records, travel to NJ or MO for an evaluation, and participate in fundraising.
Please list any questions or readiness information regarding the above question.
List Names And Ages Of All Persons Living In The Home With The Applicant/ Child
Primay Phone Number
Valid E-mail Address - this will be used for all contact with you. If it changes, please email us at
Address- must include city and zip code
How or from who did learn about Merlin's KIDS?
Job Description (parents if applying for a child)
Parent/ Guardian Full Name (s) (put n/a if applicant is an adult)
Address Of Guardian/ Caregiver only if different than Applicant's Address, including shared custody arrangements
Relationship To Applicant/ Child
n/a - applicant is an adult
Define The Applicant/ Child's Disability (Be As Specific As You Can)
Cause Of Applicant's/ Child's Disability (Be As Specific As You Can)
Define the Applicant's/ Child's Specific Need For A Service Dog and what tasks you would want the service dog to perform (Be As Specific As You Can)
Do you want the dog to attend school with the child?
Child does not attend school
n/a - applying for an adult
Check All Equipment In Use Currently
Do You Have Any Other Pets?
If Yes, List Gender, Type Of Pet, Spay/Neuter, Age, Size, Weight, Breed
Do You Have A Fenced In Yard?
no fence but would install fence
not able to install fence
If No, Please Explain Location For Exercise And Bathroom For The Dog
Merlin's KIDS can only place dogs as funding is available. Dogs commonly cost between $24,000 to $30,000. Merlin’s Kids subsidizes a portion of the cost so that families are asked to fund raise between $15,000 to $18,000, barring location, cost of travel, and special circumstances. We ask each family to fund raise and/or apply for grants, much of which can be done online. Grants from Merlin's KIDS are prioritized based on a family's active fundraising and full participation in the process.
I have already raised funds to be donated towards a service dog and will continue to fundraise.
I will participate in Active Fundraising and grant applications.
If You Already Have Funds raised to donate, or would like to get started on fundraising, please let us know below.
Electronic Signature: by typing my name below, I validate that all information is complete and correct. I understand that this is an initial inquiry, to be followed by a full application packet if chosen to move forward in the process. I understand that I will travel to NJ or MO for an evaluation if selected, and that I will be expected to fundraise for Merlin's KIDS, a 501c3 nonprofit.
Please write any additional thoughts or questions you have regarding your initial application.
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service