4 Paws 2 Freedom Online Service Dog Application
Service Dog Application for Training
Name (first and last) *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Phone *
Your answer
Email Address *
Your answer
Name of Alternate Contact Person *
Your answer
Phone Number of Alternate Contact Person *
Your answer
Are you a veteran? *
Your answer
Are you active military?
For veterans only
Your answer
Are you a combat vet?
For veterans only
Your answer
How long did you serve?
For veterans only
Your answer
Where did you serve
For veterans only
Your answer
When were you discharged?
For veterans only
MM
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DD
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YYYY
What Branch?
For veterans only
Your answer
How long have you been back in the United States?
For veterans only
Your answer
Date of Birth *
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DD
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YYYY
Where did you hear about 4Paws 2Freedom?
Your answer
Have you ever been convicted of a felony? *
Your answer
If yes, please explain
Your answer
Emergency Contact Name *
Your answer
Relationship *
Your answer
Phone
Your answer
Your Occupation
Complete this if you work or volunteer
Your answer
Employer
Your answer
Hours worked per week
Your answer
How does your employer feel about you having a service dog?
Your answer
Describe how your disability impacts you *
Your answer
Are you physically able to train your own dog? *
Training requires alot of bending, stooping, reaching, kneeling, standing, walking, sitting as well as other strenuous activity.
Your answer
How does your primary care doctor feel about you having a service dog? *
Your answer
Your answer
Are you currently in therapy with a licensed mental care provider? *
Your answer
How does your therapist/psychologist feel about you having a service dog? *
Your answer
Do you have a dog now who you wish to train to be your service dog? *
Your answer
Name of dog
If yes, Please answer this and the following questions
Your answer
Breed
Your answer
Age
Your answer
Spayed or neutered
Your answer
How long have you had your dog?
Your answer
How old was he/she when you got him/her?
Your answer
Name of your Veterinarian
Your answer
Phone number of your veterinarian
Your answer
How does your dog react to dogs he/she does not know?
Your answer
How does your dog behave around cats?
Your answer
Does your dog enjoy being around children?
Your answer
Have you ever heard your dog growl at a person?
Your answer
Has your dog ever bitten anyone?
Your answer
Has your dog ever been injured by another dog?
Your answer
Does your dog frighten easily, or is he/she jumpy? Please describe.
Your answer
What pets do you have at home?
Your answer
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